Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- miose
- bradipneia
- estado mental alterado
- resposta dramática à naloxona
Outros fatores diagnósticos
- 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
Fatores de risco
- transtorno e dependência relacionados ao uso de opioides
- abstinência recente em usuários crônicos
- dor crônica
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- tentativa terapêutica com naloxona
- eletrocardiograma (ECG)
Investigações a serem consideradas
- radiografia torácica
- radiografia abdominal
- tomografia computadorizada (TC) abdominal
- triagem de opioides na urina
- cromatografia gasosa acoplada à espectrometria de massa
Algoritmo de tratamento
Colaboradores
Autores
Ruben Thanacoody, MD, FRCP
Consultant Physician and Clinical Toxicologist
Director, National Poisons Information Service (Newcastle)
Newcastle-upon-Tyne
UK
Declarações
RT declares that he has no competing interests.
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
William Winter, MD
Staff
Gynecologic Oncologist
Northwest Cancer Specialists
Rose Quarter Cancer Center
Portland
OR
Declarações
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
Declarações
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
Declarações
AS declares that he has no competing interests.
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
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Evidence-based strategies for preventing opioid overdose: what’s working in the United States. 22 October 2020 [internet publication].Texto completo
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 aqui.
Diretrizes
- 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
- Clinical practice guideline for prescribing opioids for pain
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