Resumo
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presença de fatores de risco
- miose
- bradipneia
- estado mental alterado
- resposta dramática à naloxona
Otros factores de diagnóstico
- marcas de agulha recentes
- objetos próximos associados ao uso de drogas
- redução da motilidade gastrointestinal
- marcas de agulha antigas nos braços ou nas pernas
- estertores pulmonares
- escarro róseo e espumoso
- convulsões
- disritmias
Factores de riesgo
- história de opioides prescritos
- transtorno e dependência relacionados ao uso de opioides
- abstinência recente em usuários crônicos
- tomar opioides por injeção
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- tentativa terapêutica com naloxona
- eletrocardiograma (ECG)
Pruebas diagnósticas que deben considerarse
- radiografia torácica
- tomografia computadorizada (TC) abdominal
- radiografia abdominal
- triagem de opioides na urina
- cromatografia gasosa acoplada à espectrometria de massa
Algoritmo de tratamiento
sem pacotes de substância retidos
com pacotes de substância retidos
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
Divulgaciones
RT declares that he has contributed to the Royal College of Emergency Medicine best practice guidelines on management of opioid toxicity in emergency departments and delivered a lecture at the RCEM Annual Conference in Gateshead. He has not received any payment for this work.
Agradecimientos
Dr Ruben Thanacoody would like to gratefully acknowledge Dr Dean Olsen, a previous contributor to this topic.
Divulgaciones
DO declares that he has no competing interests.
Revisores por pares
Joseph Donroe, null
Associate Professor of Medicine
Yale School of Medicine
New Haven
CO
Divulgaciones
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
Divulgaciones
AMK has received grant funding for research into intranasal delivery of naloxone in heroin overdose.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
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 Resumen
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 Resumen
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 Resumen
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 Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Superdosagem de gama-hidroxibutirato (GHB)/gama-butirolactona (GBL)
- Superdosagem de clonidina/imidazolinas
- Superdosagem de antipsicóticos
Más DiferencialesGuías de práctica clínica
- 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
Más Guías de práctica clínicaInicie sesión o suscríbase para acceder a todo el BMJ Best Practice
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