Coma induced by intoxication.
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.
Buylaert
W A
WA
Department of Emergency Medicine, University Hospital, Gent, Belgium.
D000058:Accidental Falls; D020268:Alcohol-Induced Disorders, Nervous System / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D000435:Alcoholic Intoxication / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000931:Antidotes / Q000627:therapeutic use; D001930:Brain Injuries / Q000175:diagnosis; D003128:Coma / Q000139:chemically induced* / Q000628:therapy; D003926:Diabetic Coma / Q000175:diagnosis; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D062787:Drug Overdose / Q000175:diagnosis; D004630:Emergencies; D000431:Ethanol / Q000506:poisoning*; D005392:First Aid; D005442:Flumazenil / Q000627:therapeutic use; D005934:Glucagon / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D002534:Hypoxia, Brain / Q000209:etiology / Q000517:prevention & control; D008991:Monitoring, Physiologic; D009270:Naloxone / Q000627:therapeutic use; D009460:Neurologic Examination; D020521:Stroke / Q000175:diagnosis; D013831:Thiamine / Q000627:therapeutic use
D000931:Antidotes; D009270:Naloxone; D000431:Ethanol; D005442:Flumazenil; D005934:Glucagon; D005947:Glucose; D013831:Thiamine