水杨酸中毒:一个以证据为基础的指导心脏按压管理共识。

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Chyka PA, Erdman AR,克里斯蒂安森G,蜡点,酒啊,Manoguerra, Caravati EM,纳尔逊LS,奥尔森KR, Cobaugh DJ, Scharman EJ,伍尔夫广告,长盛工作组

水杨酸中毒:一个以证据为基础的指导心脏按压管理共识。

中国Toxicol(费拉)。2007年,45 (2):95 - 131。doi: 10.1080 / 15563650600907140。

PubMed ID
17364628 (在PubMed
]
文摘

回顾美国毒物中心2004年的数据显示,超过40000 salicylate-containing产品曝光。指导方针,决定了急诊科转诊条件和院前护理可能会优化病人的结果,避免不必要的急诊,降低医疗成本,减少患者和医护人员的生活混乱。以证据为基础的专家共识过程被用来创建指南。相关的文章被一个训练有素的医生研究抽象。初稿的指导方针是由第一作者。整个小组讨论和改进指导之前分发给二级评论者置评。面板然后改变基于二次审查意见。这条指导原则的目的是协助中毒中心人员在适当的心脏分流和初始心脏按压患者疑似暴露于水杨酸盐的管理1)描述的过程毒药专家信息应该评估暴露于水杨酸盐,2)识别关键决策元素在管理水杨酸暴露的情况下,3)提供明确、实用的建议,反映当前状态的知识,和4)识别需要进行研究。这条指导原则是基于当前的科学和临床信息的评估。专家共识小组认识到具体的病人护理的决策可能在方差与这条指导原则和病人的特权和卫生专业人员提供护理,考虑到所有的情况。 This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses: 1) Patients with stated or suspected self-harm or who are the victims of a potentially malicious administration of a salicylate, should be referred to an emergency department immediately. This referral should be guided by local poison center procedures. In general, this should occur regardless of the dose reported (Grade D). 2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion warrants referral to an emergency department for evaluation (Grade C). 3) Patients who exhibit typical symptoms of salicylate toxicity or nonspecific symptoms such as unexplained lethargy, confusion, or dyspnea, which could indicate the development of chronic salicylate toxicity, should be referred to an emergency department (Grade C). 4) Patients without evidence of self-harm should have further evaluation, including determination of the dose, time of ingestion, presence of symptoms, history of other medical conditions, and the presence of co-ingestants. The acute ingestion of more than 150 mg/kg or 6.5 g of aspirin equivalent, whichever is less, warrants referral to an emergency department. Ingestion of greater than a lick or taste of oil of wintergreen (98% methyl salicylate) by children under 6 years of age and more than 4 mL of oil of wintergreen by patients 6 years of age and older could cause systemic salicylate toxicity and warrants referral to an emergency department (Grade C). 5) Do not induce emesis for ingestions of salicylates (Grade D). 6) Consider the out-of-hospital administration of activated charcoal for acute ingestions of a toxic dose if it is immediately available, no contraindications are present, the patient is not vomiting, and local guidelines for its out-of-hospital use are observed. However, do not delay transportation in order to administer activated charcoal (Grade D). 7) Women in the last trimester of pregnancy who ingest below the dose for emergency department referral and do not have other referral conditions should be directed to their primary care physician, obstetrician, or a non-emergent health care facility for evaluation of maternal and fetal risk. Routine referral to an emergency department for immediate care is not required (Grade C). 8) For asymptomatic patients with dermal exposures to methyl salicylate or salicylic acid, the skin should be thoroughly washed with soap and water and the patient can be observed at home for development of symptoms (Grade C). 9) For patients with an ocular exposure of methyl salicylate or salicylic acid, the eye(s) should be irrigated with room-temperature tap water for 15 minutes. If after irrigation the patient is having pain, decreased visual acuity, or persistent irritation, referral for an ophthalmological examination is indicated (Grade D). 10) Poison centers should monitor the onset of symptoms whenever possible by conducting follow-up calls at periodic intervals for approximately 12 hours after ingestion of non-enteric-coated salicylate products, and for approximately 24 hours after the ingestion of enteric-coated aspirin (Grade C).

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