title: Glasgow Coma Scale in acute poisonings before and after use of antidote in patients with history of use of psychotropic agents.
abstract: BACKGROUND
  Data on emergency interventions in poisonings are scarce. Objective To determine the effectiveness of antidote therapy in acute poisoning-related emergency medical services (EMS) interventions.
  
  
  METHODS
  A prospective observational study included all poisoning-related intervention cases over 3 years (1999-2001) in the Celje region, Slovenia, covering 125,000 inhabitants. Data were recorded on an EMS form.
  
  
  RESULTS
  Psychoactive agents were present in 56.5% out of 244 poisoning-related EMS interventions. Prescription drugs were a cause of intoxication in 93 (39.2%) cases alone or in combination with alcohol or illegal drugs. More than one fifth of poisonings were due to the use of illegal drugs in 52 (21.9%) cases, 43 (18.1%) out of them heroin related. At the time of EMS arrival, more patients who ingested illegal drugs were in coma or comatose than the rest. 24 (45.3%) vs. 32 (17.3%) of poisoned patients were in coma (p < 0.001). Glasgow Coma Scale (GCS) at the first contact was lower in patients who ingested illegal drugs than in the remaining patients (9.0 vs. 11.6, p = 0.001). In 23.2% of the cases, an antidote was administered. In 29 (12.2%) naloxone and in 16 (6.7%) flumazenil was administered. Mean GCS after intervention was higher in all cases but significantly higher in illegal drug cases, 13.4 vs. 12.2 (p = 0.001), with a mean positive change in GCS of 4.5 vs. 0.6 (p < 0.001). In illegal drug users, mean change after antidote administration was 8.2 vs. 0.5 without antidote administration (p < 0.001).
  
  
  CONCLUSIONS
  High rate of successful antidote use during the intervention indicated the importance of good EMS protocols and the presence of a skilled doctor in the EMS team.
authors.affiliation: Department of Family Medicine, Ljubljana, Slovenia.
authors.forename: Tonka
authors.initials: T
authors.lastname: Poplas-Susić
authors.forename: Zalika
authors.initials: Z
authors.lastname: Klemenc-Ketis
authors.forename: Marija
authors.initials: M
authors.lastname: Komericki-Grzinić
authors.forename: Janko
authors.initials: J
authors.lastname: Kersnik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000931:Antidotes / Q000627:therapeutic use*; D002648:Child; D003128:Coma / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use; D015600:Glasgow Coma Scale; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D011041:Poisoning / Q000188:drug therapy* / Q000503:physiopathology; D011619:Psychotropic Drugs / Q000506:poisoning / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000931:Antidotes; D013287:Illicit Drugs; D009292:Narcotic Antagonists; D011619:Psychotropic Drugs; D009270:Naloxone; D005442:Flumazenil