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1.
Vnitr Lek ; 65(6): 425-432, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484483

RESUMO

The second part of the review deals in detail with the diagnostics and treatment of toxic alcohols poisoning and management and indication of extracorporeal removal techniques in intoxication with other drugs, theophylline, valproic acid, metformin and metformin associated lactic acidosis, respectively. The extracorporeal treatment enhances the clearance of the toxin and corrects patients metabolic disturbances as well. It is necessary to use this treatment in severe intoxications. Indication of this invasive procedure falls within clinicians and nephrologists competence being advised by a toxicologist. This review could help make fast decisions.


Assuntos
Acidose Láctica , Overdose de Drogas , Hipoglicemiantes , Metformina , Overdose de Drogas/terapia , Humanos , Hipoglicemiantes/farmacocinética , Metformina/farmacocinética , Diálise Renal , Teofilina
2.
Expert Rev Clin Pharmacol ; 12(9): 901-908, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31422705

RESUMO

Introduction: The current emphasis on combatting the opioid epidemic in the United States and across the globe is well warranted, but rates and variations of other drugs and substances of abuse may be inadvertently increasing as well. These drugs and substances deserve equal attention in the literature to equip healthcare practitioners with the knowledge to provide optimal care in overdose patients. Areas covered: This evaluation includes loperamide, gabapentin, and modafinil and was accomplished through a comprehensive literature review of PubMed, MEDLINE, SCOPUS, ProQuest Central, ProQuest Dissertations, and CINAHL. The results of forty-four pieces of literature are included in this evaluation. The objective of this review is to provide a repository of standard and emerging treatment modalities for loperamide, gabapentin and modafinil for the emergency medicine team. Expert opinion: Loperamide, gabapentin, and modafinil are becoming drugs of abuse, and as such, should be on the radar of healthcare providers. Recognizing their unique toxicity profiles is imperative in providing optimal resuscitative care.


Assuntos
Gabapentina/envenenamento , Loperamida/envenenamento , Modafinila/envenenamento , Overdose de Drogas/terapia , Tratamento de Emergência/métodos , Humanos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
4.
Tidsskr Nor Laegeforen ; 139(9)2019 May 28.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31140247

RESUMO

BACKGROUND: A woman in her fifties was admitted to hospital with decreased awareness and circulatory failure. She had been treated with left atrial cryoablation a few weeks before admission and had been cardioverted a few days after the procedure because of relapse of atrial fibrillation. CASE PRESENTATION: On admission, the patient had systolic blood pressure of 80 mm Hg and an ECG with broad QRS-complexes at 380 ms. We suspected intoxication and she was intubated to administer activated charcoal after gastric lavage. She was cardiovascularly unstable and in need of intravenous infusion of noradrenaline and adrenaline. Further investigations at her home suggested that she had poisoned herself with 4-5 g flecainide, 0.3 g oxazepam and 0.5 g meclizine. After administration of 500 mmol sodium bicarbonate and 5 mmol calcium chloride, the QRS complexes narrowed temporarily. On day 2, due to sustained bradycardia and hypotension despite receiving adrenergic medications, a temporary pacemaker was implanted, leading to improved heart rate and blood pressure. She experienced several complications including hypertensive pulmonary oedema, atrial fibrillation, extensively prolonged QT interval because of polypharmacy and Takotsubo cardiomyopathy. She was discharged from the hospital in good health on day 17. At a follow-up visit at the outpatient clinic 12 weeks later, cardiac function had normalised. The QT interval was now normal; however, there were persistent T-wave inversions in leads I, aVL and V4-6. INTERPRETATION: Flecainide blocks sodium channels in cardiomyocytes. Intoxication with flecainide is rare, with mortality rates of about 10 %. Sodium bicarbonate in larger doses has been reported to stabilise patients with flecainide intoxication due to modification of the binding of flecainide to sodium receptors in cardiomyocytes, and due to alkalisation which makes flecainide detach from sodium receptors. Our patient had a temporary effect with narrowing of QRS complexes after receiving sodium bicarbonate. She also showed a beneficial effect from implantation of a temporary pacemaker, although earlier case reports have described problems with high thresholds and capture failure.


Assuntos
Antiarrítmicos/envenenamento , Overdose de Drogas , Flecainida/envenenamento , Carvão Vegetal/uso terapêutico , Overdose de Drogas/complicações , Overdose de Drogas/terapia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Marca-Passo Artificial , Choque/induzido quimicamente , Choque/terapia , Sonolência , Bicarbonato de Sódio/uso terapêutico
5.
BMJ Case Rep ; 12(4)2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954964

RESUMO

An 84-year-old woman presented to hospital with severe clinical and metabolic sequelaesequelae of a massive paracetamol overdose (concentration=822 mg/L). In spite of N-acetylcysteine therapy, she deteriorated with evidence of mitochondrial dysfunction. Although the EXtracorporeal TReatments In Poisoning group recommend adjunct haemodialysis (HD) in such a context, this was difficult to start due to haemodynamic instability. Instead, a trial of continuous venovenous haemodiafiltration (CVVHDF) was initiated in an attempt to restore normal mitochondrial function, normal pH and to actively remove the offending drug. Fortunately, plasma paracetamol levels fell exponentially over the subsequent 24-48 hours without the need to commence HD. The patient made a full recovery and was later discharged from the hospital. This case highlights that CVVHDF can be a reasonable alternative to HD for managing massive paracetamol overdoses in the context of mitochondrial dysfunction.


Assuntos
Acetaminofen/envenenamento , Analgésicos não Entorpecentes/envenenamento , Overdose de Drogas/terapia , Hemodiafiltração , Acetilcisteína/administração & dosagem , Idoso de 80 Anos ou mais , Antídotos/administração & dosagem , Overdose de Drogas/fisiopatologia , Feminino , Humanos , Tentativa de Suicídio , Resultado do Tratamento
7.
Epidemiology ; 30(3): 365-370, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30882402

RESUMO

BACKGROUND: Opioid misuse is a major public health issue in the United States and in particular the state of Ohio. However, the burden of the epidemic is challenging to quantify as public health surveillance measures capture different aspects of the problem. Here, we synthesize county-level death and treatment counts to compare the relative burden across counties and assess associations with social environmental covariates. METHODS: We construct a generalized spatial factor model to jointly model death and treatment rates for each county. For each outcome, we specify a spatial rates parameterization for a Poisson regression model with spatially varying factor loadings. We use a conditional autoregressive model to account for spatial dependence within a Bayesian framework. RESULTS: The estimated spatial factor was highest in the southern and southwestern counties of the state, representing a higher burden of the opioid epidemic. We found that relatively high rates of treatment contributed to the factor in the southern part of the state, whereas relatively higher rates of death contributed in the southwest. The estimated factor was also positively associated with the proportion of residents 18-64 years of age on disability and negatively associated with the proportion of residents reporting white race. CONCLUSIONS: We synthesized the information in the opioid-associated death and treatment counts through a spatial factor model to estimate a latent factor representing the consensus between the two surveillance measures. We believe this framework provides a coherent approach to describe the epidemic while leveraging information from multiple surveillance measures.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/mortalidade , Overdose de Drogas/terapia , Admissão do Paciente/estatística & dados numéricos , Vigilância da População/métodos , Adolescente , Adulto , Teorema de Bayes , Humanos , Pessoa de Meia-Idade , Ohio/epidemiologia , Análise Espacial , Adulto Jovem
9.
Drug Alcohol Rev ; 38(2): 131-150, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30785229

RESUMO

ISSUES: Preventable overdose deaths, especially due to opioids, have increasingly been reported worldwide. Expansion of life-saving harm reduction services is underway with increasing public support in some jurisdictions. However, such services often fall short of reaching people who use drugs (PWUD), in part, due to law enforcement practices that are aligned with punitive drug laws and incongruent with harm reduction principles. One suggested strategy to facilitate police understanding and uptake of practices that are more congruent with harm reduction is to provide police with relevant training. APPROACH: This scoping review synthesises English-language peer-reviewed and grey literature on harm reduction training programs for police. KEY FINDINGS: We reviewed 31 sources and found that most trainings covered topics related to harm reduction objectives, overdose recognition and response, occupational safety and policing practices. Information was often presented via single-session, 1-hour long, slide-assisted presentations that were integrated into in-service trainings. Inconsistent throughout the literature was the career stage or position/rank of training audience (e.g. cadets, senior officers, street-level officers), when and how much training should be provided, and the occupational background of the training facilitator. IMPLICATIONS: The available literature contains significant gaps pertaining to descriptions of training development, design and content specific to facilitating positive police-PWUD interactions, and formal evaluations. These gaps limit our understanding of what well-designed trainings may look like, if and how training alters policing practices, and to what extent training completion may lead to improved outcomes. CONCLUSION: Greater research and formal evaluations of harm reduction training for police is recommended.


Assuntos
Redução do Dano , Polícia/educação , Overdose de Drogas/terapia , Humanos
10.
PLoS One ; 14(1): e0210129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30629607

RESUMO

INTRODUCTION: British Columbia (BC), Canada declared a public health emergency in April 2016 for opioid overdose. Comprehensive data was needed to identify risk factors, inform interventions, and evaluate response actions. We describe the development of an overdose cohort, including linkage strategy, case definitions, and data governance model, and present the resulting characteristics, including data linkage yields and case overlap among data sources. METHODS: Overdose events from hospital admissions, physician visits, poison centre and ambulance calls, emergency department visits, and coroner's data were grouped into episodes if records were present in multiple sources. A minimum of five years of universal health care records (all prescription dispensations, fee-for-service physician billings, emergency department visits and hospitalizations) were appended for each individual. A 20% random sample of BC residents and a 1:5 matched case-control set were generated. Consultation and prioritization ensured analysts worked to address questions to directly inform public health actions. RESULTS: 10,456 individuals suffered 14,292 overdoses from January 1, 2015 to Nov 30, 2016. Only 28% of overdose events were found in more than one dataset with the unique contribution of cases highest from ambulance records (32%). Compared with fatal overdoses, non-fatal events more often involved females, younger individuals (20 to 29 years) and those 60 or older. In 78% of illegal drug deaths, there was no associated ambulance response. In the year prior to first recorded overdose, 60% of individuals had at least one ED visit, 31% at least one hospital admission, 80% at least one physician visit, and 87% had filled at least one prescription in a community pharmacy. CONCLUSION: While resource-intensive to establish, a linked cohort is useful for characterizing the full extent of the epidemic, defining sub-populations at risk, and patterns of contact with the health system. Overdose studies in other jurisdictions should consider the inclusion of multiple data sources.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/epidemiologia , Epidemias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Drogas Ilícitas/envenenamento , Adolescente , Adulto , Colúmbia Britânica/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Conjuntos de Dados como Assunto , Overdose de Drogas/etiologia , Overdose de Drogas/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Epidemias/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/terapia , Projetos de Pesquisa , Taxa de Sobrevida , Adulto Jovem
12.
J Vet Intern Med ; 33(2): 596-602, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30698297

RESUMO

BACKGROUND: Therapeutic plasma exchange (TPE) may be an effective technique for treatment of accidental nonsteroidal anti-inflammatory drug (NSAID) overdose, but information regarding the use of this technique in veterinary medicine is currently limited. OBJECTIVES: To evaluate the overall outcome for dogs with NSAID overdose treated with TPE and to determine if any presenting factors can predict or influence overall outcome. Secondary objectives included investigating TPE complications as well as the utility of other adjunctive treatments. ANIMALS: Eleven client-owned dogs presented for NSAID overdose that received TPE. All patients also received additional supportive treatment including IV lipid infusion. METHODS: Retrospective review of medical records. RESULTS: Eleven cases were included in the study. Of these, the NSAID ingested was ibuprofen in 6 (54.5%), naproxen in 4 (36.4%), and deracoxib in 1 (9.1%). All dogs survived to discharge with 3 (27.3%) developing acute kidney injury during hospitalization. A larger initial dose of NSAID ingested was associated with a higher maximum serum creatinine concentration during hospitalization (P = .04) and larger change in serum creatinine concentration from baseline (P = .02). Six dogs (54.5%) developed complications associated with TPE. The use of other treatments did not affect the overall outcome. CONCLUSIONS AND CLINICAL IMPORTANCE: We identified TPE as an effective treatment for NSAID overdose with good outcomes despite high doses of NSAID ingestion in dogs treated with a single TPE treatment. Complications were common but did not affect the final outcome. Therapeutic plasma exchange should be considered in patients presenting for high-dose NSAID ingestion.


Assuntos
Anti-Inflamatórios não Esteroides/envenenamento , Doenças do Cão/terapia , Overdose de Drogas/veterinária , Troca Plasmática/veterinária , Animais , Cães , Overdose de Drogas/terapia , Feminino , Masculino , Registros/veterinária , Estudos Retrospectivos
13.
Am J Public Health ; 109(2): 303-305, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30571299

RESUMO

OBJECTIVES: To examine opioid-related outcomes by using hospitalization and mortality data as an indicator of the current opioid crisis in West Virginia. METHODS: We used data from the West Virginia University Medicine health care system to examine the trend in opioid overdoses and percentage of patients with a repeat overdose from 2008 to 2016. We obtained the opioid overdose death rate for the state from Centers for Disease Control and Prevention WONDER (Wide-ranging ONline Data for Epidemiologic Research) mortality data for 2008 to 2016. RESULTS: The hospitalization rate for opioid overdoses increased (13%) on average each year in a similar fashion to the opioid overdose death rate for the state (12%) between 2008 and 2016. During the same time, the percentage of patients with a repeat opioid overdose increased annually by 13% on average. CONCLUSIONS: There continues to be a surge of opioid overdoses in West Virginia. These findings suggest a need to amplify comprehensive prevention and treatment efforts throughout the state. Public health initiatives to reduce the morbidity and mortality associated with overdoses should consider how the changes in potency may be influencing these outcomes.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Drogas/mortalidade , Transtornos Relacionados ao Uso de Opioides/mortalidade , Overdose de Drogas/terapia , Hospitalização/estatística & dados numéricos , Humanos , Transtornos Relacionados ao Uso de Opioides/terapia , Saúde Pública , Estudos Retrospectivos , West Virginia/epidemiologia
14.
Am J Public Health ; 109(2): 263-266, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30571304

RESUMO

In March 2017, Rhode Island released treatment standards for care of adult patients with opioid use disorder. These standards prescribe three levels of hospital and emergency department treatment and prevention of opioid use disorder and opioid overdose and mechanisms for referral to treatment and epidemiological surveillance. By June 2018, all Rhode Island licensed acute care facilities had implemented policies meeting the standards' requirements. This policy has standardized care for opioid use disorder, enhanced opioid overdose surveillance and response, and expanded linkage to peer recovery support, naloxone, and medication for opioid use disorder.


Assuntos
Overdose de Drogas , Serviço Hospitalar de Emergência/legislação & jurisprudência , Transtornos Relacionados ao Uso de Opioides , Alta do Paciente/legislação & jurisprudência , Overdose de Drogas/prevenção & controle , Overdose de Drogas/terapia , Serviço Hospitalar de Emergência/economia , Custos Hospitalares , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/terapia , Saúde Pública , Rhode Island
15.
BMC Infect Dis ; 18(1): 665, 2018 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-30558553

RESUMO

BACKGROUND: Intra-osseous (IO) access is recommended in cases of pre-hospital emergency or resuscitation when intravascular (IV) route is difficult or impossible. Despite recent improvement in IO devices and increasing indications, it remains rarely used in practice. Various complications have been reported but are uncommon. CASE PRESENTATION: We report a case of massive acute tibial osteomyelitis in an adult male three months after an IO catheter insertion for emergency drug infusion. We review the literature on association between IO access and acute osteomyelitis in children and adults. CONCLUSIONS: Emergency-care givers and radiologists should be informed about this infrequent complication in order to make early diagnosis and initiate adequate antibiotic therapy.


Assuntos
Infecções Relacionadas a Cateter/etiologia , Overdose de Drogas/terapia , Infusões Intraósseas/efeitos adversos , Osteomielite/etiologia , Ressuscitação , Tíbia/microbiologia , Doença Aguda , Adulto , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Serviços Médicos de Emergência , Humanos , Doença Iatrogênica , Masculino , Osteomielite/microbiologia , Osteomielite/patologia , Ressuscitação/efeitos adversos , Ressuscitação/métodos , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/patologia , Staphylococcus aureus/isolamento & purificação , Tíbia/patologia
17.
J Stud Alcohol Drugs ; 79(6): 893-898, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30573020

RESUMO

OBJECTIVE: Research suggests unintentional overdose on prescription drugs and intentional self-harm cases differ fundamentally from unintentional illicit drug overdoses, but there are few data on opioid overdose per se. METHOD: We analyzed consecutive opioid overdose patients age 13 and over (N = 435) treated by a toxicology consult service to compare three poisoning groups: unintentional illicit drug (illicit, n = 128), unintentional prescription drug (prescription, n = 217), and intentional self-harm (self-harm, n = 90). The groups were compared on key characteristics of the poisoning events (severity, co-ingestion of non-opioid) and the hospital-based treatments required to manage the poisonings (use of antidote, provision of pharmacological support). Logistic regressions yielded incident rate ratios (IRRs) and 95% confidence intervals (CI) adjusted for age and sex. RESULTS: Compared to the illicit group, the prescription group was more likely to co-ingest a non-opioid drug (IRR [95% CI] = 1.594 [1.077, 2.358], p = .020. Compared to illicit cases, self-harm cases were more likely to co-ingest a non-opioid drug (IRR = 3.181 [1.620, 6.245], p = .001) and had a lower poisoning severity score (IRR = 0.750 [0.564, 0.997], p = .048). There were no statistically significant differences between the self-harm and prescription groups. CONCLUSIONS: The similarities between the self-harm and prescription poisoning groups suggest that they may benefit from common interventions including appropriate restriction on prescription of opioids and other medications that may be misused (e.g., sedative-hypnotic/muscle relaxants). The characteristics of the illicit poisoning group (use of heroin; more severe overdose events) suggest the need for initiation of intensive substance use treatment interventions during hospitalization.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Drogas/terapia , Medicamentos sob Prescrição/efeitos adversos , Comportamento Autodestrutivo/terapia , Drogas Ilícitas/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Estudos Transversais , Overdose de Drogas/diagnóstico , Overdose de Drogas/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/psicologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
18.
J Stud Alcohol Drugs ; 79(6): 899-908, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30573021

RESUMO

OBJECTIVE: Opioid use disorder (OUD) and overdose rates have been sharply on the rise in the United States. Although systematic patterns of geographic variation in OUD and opioid overdose have been identified, the factors that explain why opioid-related hospitalizations increase in certain areas are not well understood. METHOD: We examined Pennsylvania Health Care Cost Containment Council (PHC4) hospital inpatient discharge data at the ZIP code level to measure the geographic growth and spread of OUD as measured by 44 quarters of inpatient hospitalization data (from 2004 through 2014) for the entire state of Pennsylvania (n = 16,275 ZIP codes). We assessed the relative contribution of specific attributes of areas (e.g., population density) to patterns of OUD, heroin poisonings, and non-heroin opioid poisonings. Unit misalignment and spatial autocorrelation were corrected for using Bayesian space-time conditional autoregressive models. RESULTS: The associations between a greater density of manual labor establishments and all opioid-related hospitalizations were well supported and positive. A dose-response relationship between population density and opioid-related hospitalizations existed, with a stronger association for heroin poisonings (relative rate, densest quintile vs. least dense: 3.40 [95% credible interval 2.68, 4.39]). CONCLUSIONS: Posterior distributions from these models enabled the identification of locations most vulnerable to problems related to the opioid epidemic in Pennsylvania. Understanding spatial patterns of OUD and poisonings can enhance the development and implementation of effective prevention programs.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/epidemiologia , Hospitalização/tendências , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Meio Social , Adolescente , Adulto , Teorema de Bayes , Criança , Pré-Escolar , Overdose de Drogas/diagnóstico , Overdose de Drogas/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Entorpecentes/envenenamento , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/terapia , Alta do Paciente/tendências , Pennsylvania/epidemiologia , Adulto Jovem
19.
Medicine (Baltimore) ; 97(45): e13129, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30407335

RESUMO

RATIONALE: Lithium has been used to treat bipolar disorder. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Lithium intoxication can be fatal and is difficult to diagnose in patients without a history of lithium intake. The occurrence of serious cardiac arrhythmias is rare in lithium intoxication. PATIENT CONCERNS: An 81-year-old man was brought to the emergency department because of consciousness disturbance for 2 days. According to his daughter, he had a history of hypertension and diabetes. Recently, his family also observed slurring of speech and easy choking. The physical examination findings were unremarkable. DIAGNOSIS: Blood examination only revealed impaired renal function. Twelve-lead electrocardiography revealed sinus rhythm with first-degree atrioventricular block. Chest radiography revealed mediastinal widening. The blood pressures obtained from the 4 limbs showed no significant differences. Subsequently, brain computed tomography revealed no obvious intracranial lesion. A neurologist was consulted, and a recent ischemic stroke could not be ruled out. While in the observation area, his systolic blood pressure decreased to <90 mm Hg and he showed bradycardia, and 12-lead electrocardiography revealed an AV block and long pulse. Contrast-enhanced chest computed tomography revealed no evidence of aortic dissection. Another family member reported a history of lithium intake for bipolar disorder for >30 years. Blood examination revealed a lithium concentration of 2.65 mEq/L. INTERVENTIONS: A nephrologist was consulted, and emergency hemodialysis was indicated. Dopamine was administered for his shock status via a right neck central venous catheter. OUTCOMES: His lithium level gradually declined after the hemodialysis, and blood pressure and consciousness level improved subsequently. The patient was discharged 9 days later in a stable condition. LESSONS: If an emergency physician encounters a patient with altered consciousness and arrhythmia with cardiogenic shock, the patient's drug intake history should be carefully reviewed to rule out cardiovascular problems on the basis of the patient's clinical condition.


Assuntos
Antidepressivos/envenenamento , Overdose de Drogas/diagnóstico , Compostos de Lítio/envenenamento , Idoso de 80 Anos ou mais , Antidepressivos/sangue , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Cardiotônicos/uso terapêutico , Transtornos da Consciência/etiologia , Dopamina/uso terapêutico , Overdose de Drogas/terapia , Eletrocardiografia , Humanos , Compostos de Lítio/sangue , Masculino , Diálise Renal/métodos , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia
20.
Drug Alcohol Depend ; 190: 6-8, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29960202

RESUMO

OBJECTIVES: A growing body of research points to increasing peer involvement in programs for people who use drugs, although this work has focused primarily on naloxone education and distribution. This study extends this work by examining the roles of peers in leading a novel overdose response program within emergency shelters. METHODS: Semi-structured qualitative interviews were conducted with 24 people who use drugs, recruited from two emergency shelters, as well as ethnographic observation in these settings. Interviews were transcribed and analyzed thematically with attention to peer roles. RESULTS: Four themes emerged from the data. First, participants discussed the development of peer support through relationship building and trust. Second, participants described a level of safety using drugs in front of peer workers due to their shared lived experience. Third, peer workers were described as favorable compared to non-peer staff because of nominal power dynamics and past negative experiences with non-peer staff. Last, given the context of the overdose crisis, peer worker roles were often routinized informally across the social networks of residents, which fostered a collective obligation to respond to overdoses. CONCLUSIONS: Findings indicate that participants regarded peer workers as providing a range of unique benefits. They emphasized the critical role of both social networks and informal roles in optimizing overdose responses. The scaling up of peer programming in distinct risk environments such as emergency shelters through both formal and informal roles has potential to help improve overdose prevention efforts, including in settings not well served by conventional public health programming.


Assuntos
Overdose de Drogas/psicologia , Overdose de Drogas/terapia , Abrigo de Emergência/métodos , Preferência do Paciente/psicologia , Grupo Associado , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Fatores de Risco
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