小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 瞳孔缩小
- 呼吸迟缓
- 意识状态改变
- 对纳洛酮有剧烈反应
其他诊断因素
- 新鲜针孔
- 随身物品里有吸毒用具
- 胃肠动力减弱
- 手臂和腿上有旧针孔
- 肺部啰音
- 泡沫样粉红痰
- 惊厥
- 心律失常
危险因素
- 阿片类药物滥用和依赖
- 长期用药者的近期戒断
- 慢性疼痛
诊断性检查
首要检查
- 纳洛酮治疗试验
- 心电图 (ECG)
需考虑的检查
- 胸部 X 线检查
- 腹部 X 线检查
- 腹部 CT 扫描
- 阿片类药物尿检筛查
- 气相色谱法/质谱法
治疗流程
有阿片类药物过量或中毒征象的患者：心脏停搏时
有阿片类药物过量或中毒征象的患者：未发生心脏停搏
撰稿人
作者
Ruben Thanacoody, MD, FRCP
Consultant Physician and Clinical Toxicologist
Director, National Poisons Information Service (Newcastle)
Newcastle-upon-Tyne
UK
利益声明
RT declares that he has no competing interests.
鸣谢
Dr Ruben Thanacoody would like to gratefully acknowledge Dr Dean Olsen, a previous contributor to this topic.
利益声明
DO declares that he has no competing interests.
同行评议者
William Winter, MD
Staff
Gynecologic Oncologist
Northwest Cancer Specialists
Rose Quarter Cancer Center
Portland
OR
利益声明
WW 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
利益声明
AMK has received grant funding for research into intranasal delivery of naloxone in heroin overdose.
Andrew Stolbach, MD
Assistant Professor
Johns Hopkins University
Baltimore
MD
利益声明
AS declares that he has no competing interests.
鉴别诊断
- γ-羟基丁酸 (gammahydroxybutyrate, GHB)/γ-丁内酯 (gammabutyrolactone, GBL) 过量
- 可乐定/咪唑啉类过量
- 抗精神病药物过量
更多 鉴别诊断指南
- 2021 年复苏指南
- 与阿片类药物相关的院外心脏停搏：独有临床特征以及对医疗保健和公众反应的影响——美国心脏协会的科学声明
更多 指南
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明