Summary
Definition
História e exame físico
Principais fatores diagnósticos
- presence of risk factors
- miosis
- bradypnoea
- altered mental status
- dramatic response to naloxone
Outros fatores diagnósticos
- fresh needle marks
- drug paraphernalia nearby
- decreased gastrointestinal motility
- old track marks on arms and legs
- pulmonary rales
- frothy pink sputum
- seizures
- dysrhythmias
Fatores de risco
- history of prescribed opioids
- opioid use disorder and dependence
- recent abstinence in chronic users
- taking opioids by injection
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- therapeutic trial of naloxone
- Electrocardiogram (ECG)
Investigações a serem consideradas
- chest x-ray
- abdominal CT scan
- abdominal x-ray
- opioid urine screen
- gas chromatography/mass spectrometry
Algoritmo de tratamento
without retained drug packages
with retained drug packages
Colaboradores
Autores
Ruben Thanacoody, MD, FRCP, FRCP(Edin), FEAPCCT
Consultant Physician and Clinical Toxicologist
Director, National Poisons Information Service (Newcastle)
Honorary Clinical Senior Lecturer, Newcastle University
Newcastle-upon-Tyne
UK
Declarações
RT declares that he has no competing interests. RT is an author of a reference cited in this topic.
Agradecimentos
Dr Ruben Thanacoody would like to gratefully acknowledge Dr Dean Olsen, a previous contributor to this topic.
Declarações
DO declares that he has no competing interests.
Revisores
Joseph Donroe, null
Associate Professor of Medicine
Yale School of Medicine
New Haven
CO
Declarações
JD declares that he has no competing interests.
Anne-Maree Kelley, MD, MClinEd, FACEM
Director
Joseph Epstein Centre for Emergency Medicine Research
Western Health Sunshine Hospital
St Albans
Australia
Declarações
AMK has received grant funding for research into intranasal delivery of naloxone in heroin overdose.
Referências
Principais artigos
Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95.Texto completo Resumo
Dezfulian C, Orkin AM, Maron BA, et al. Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association. Circulation. 2021 Apr 20;143(16):e836-70.Texto completo Resumo
Resuscitation Council UK. 2021 resuscitation guidelines. 2021 [internet publication].Texto completo
Williams K, Lang ES, Panchal AR, et al. Evidence-based guidelines for EMS administration of naloxone. Prehosp Emerg Care. 2019 Nov-Dec;23(6):749-63.Texto completo Resumo
Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023 Oct 17;148(16):e149-84.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Gammahydroxybutyrate (GHB)/gammabutyrolactone (GBL) overdose
- Clonidine/imidazolines overdose
- Antipsychotic overdose
Mais Diagnósticos diferenciaisDiretrizes
- Joint RCEM and NPIS best practice guideline: assessment and management of acute opioid toxicity in adults in the emergency department
- 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care
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