Search PubMed⌕ Search
Home/Archive/PubMed

PubMed · 11233676

Coma induced by intoxication.

W A Buylaert
View original source ↗Export metadata ↓

Abstract

Clinicians in the emergency department are often confronted with coma patients due to poisoning. A systematic general approach involving early consultation with a neurologist is of paramount importance. A high index of suspicion, a systematic first assessment already in the prehospital phase and early stabilisation of vital functions are the essential first steps. Specific antidotes like hypertonic glucose and thiamine are part of a "coma cocktail". The opiate antagonist naloxone should be used only when clinically indicated and in a titrated way. Flumazenil should only be used with caution and in restricted cases. Clinical neurological evaluation and technical investigations like CT-scan and laboratory tests should make part of a careful diagnostic plan. Toxicological tests deserve their place in the diagnostic work up of a coma patient with suspected poisoning. Knowledge of the possibilities of the toxicology lab and optimal communication with the clinical toxicologist is important for optimal patient care.

Explore related subjects

Accidental FallsAlcohol-Induced Disorders, Nervous SystemAlcoholic IntoxicationAntidotesBrain InjuriesComaDiabetic ComaDiagnosis, DifferentialDiagnostic Tests, RoutineDrug OverdoseEmergenciesEthanolFirst AidFlumazenilGlucagonGlucoseHumansHypoglycemiaHypoxia, BrainMonitoring, PhysiologicNaloxoneNeurologic ExaminationStrokeThiamineJournal ArticleReview

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

W A Buylaert. 2000. Coma induced by intoxication.. https://pubmed.ncbi.nlm.nih.gov/11233676/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2001

Aneurysm of the internal carotid artery following soft tissue penetration injury.

Aneurysms of the extracranial arteries are in most cases secondary to atherosclerosis but may also be due to degeneration, congenital abnormalities, trauma or unclear etiology. They present either with bulging in the lateral pharyngeal wall or the neck. Therefore, otolaryngologists are often among the first physicians to see the patient. In this report, we present a case of spontaneous oral bleeding that was caused by a pseudoaneurysm following 2 weeks after a soft tissue penetration injury in a child. The facial swelling of the child was initially diagnosed to be mumps by its pediatrician and the fever treated with aspirin. A pseudonaneurysm of the internal carotid artery was identified by arteriography as the source of the abrupt oral bleeding and required immediate surgical treatment including radiological means. Our report should illustrate the importance of careful preoperative evaluation as well as a high index of suspicion especially in children, where evaluation of history is difficult.

Accidental Falls↗
PubMed2001

Fetal deaths related to maternal injury.

CONTEXT: Maternal and fetal trauma is an important cause of adverse fetal outcomes. However, systematic exclusion from US injury surveillance programs of even the most severe outcome, fetal/neonatal death, has led to a lack of understanding about frequency, causes, and prevention. OBJECTIVE: To determine the rate of traumatic fetal deaths reported in state fetal death registries and the types of trauma and physiologic diagnoses associated with these deaths. DESIGN AND SETTING: Retrospective descriptive study of fetal death certificates from 1995 through 1997 obtained from 16 states, which accounted for 55% of US live births and approximately 15 000 fetal death registrations per year. MAIN OUTCOME MEASURE: Rate of fetal injury deaths, based on fetal death certificates coded with an underlying cause of death due to maternal injury at 20 weeks' gestation or later, by cause. RESULTS: During the 3-year study period, 240 traumatic fetal injury deaths were identified (3.7 fetal deaths per 100 000 live births). Motor vehicle crashes were the leading trauma mechanism (82% of cases; 2.3 fetal deaths per 100 000 live births), followed by firearm injuries (6% of cases) and falls (3% of cases). In 3 states, reported crash-related fetal deaths exceeded that of crash-related infant deaths. Placental injury was mentioned in 100 cases (42%) and maternal death was noted in 27 cases (11%). A peak rate of 9.3 fetal deaths per 100 000 live births was observed among 15- to 19-year-old women. CONCLUSIONS: Motor vehicle crashes are the leading cause of fetal deaths related to maternal trauma. Improved tracking of traumatic fetal injury deaths is important to stimulate and guide research and efforts to reduce the risks to women and fetuses from injury during pregnancy.

Accidental Falls↗
PubMed2001

[Effectiveness of a multifactorial intervention to prevent falls among elderly people in a community].

INTRODUCTION: The falls of old people are a common problem that will increase as the population ages and which are accompanied by high morbidity and mortality. Multifactorial intervention has proved effective in reducing the number of falls. OBJECTIVE: To reduce the number of falls and their complications in the population >= 70 years old of a health district through a multifactorial community intervention programme. METHOD: Multi-centred community intervention quasi-experimental study with no randomised allocation. It will be run in two communities, viz Salt and Girona-4, both of which are health districts in the province of Girona. In both an initial study will seek to establish the prevalence of falls and their consequences in people >= 70 years old. Data will be obtained from several randomised samples, using a questionnaire drawn up for the purpose. A multifactorial community intervention lasting two years (intervention group) will be made in the Salt Health District. There will be no specific intervention in the other community (control group). Later, effectiveness will be evaluated through randomised samples given the same questionnaire. DISCUSSION: Possible limitations of the study are the effect of contamination between the two communities, the existence of factors external to the intervention programme, losses due to people moving and deaths, and difficulty in assessing community activity. This programme can be applied to other communities as part of care and health education activities undertaken by primary care teams.

Accidental Falls↗