呼吸囊面罩人工通气合用纳络酮抢救急性重度海洛因中毒18例分析

目的：探讨急性重度海洛因中毒的有效救治方法。方法：回顾性分析我院近3年来采用呼吸囊面罩人工通气及静脉应用纳络酮抢救18例重度海洛因中毒的临床资料。结果：18例患者经抢救后16例成功，成功率88．9％。结论：采用呼吸囊面罩人工通气合用纳络酮能有效地改善重度海洛因中毒患者机体缺氧，促进病人苏醒，且方法简便。适合于基层医院推广应用。     

纳络酮抢救急性海络因中毒43例临床分析

目的 :探讨纳络酮抢救急性海洛因中毒临床应用价值 ,包括症状缓解和催醒情况 ,解决呼吸抑制情况。方法 :分析总结纳络酮为主抢救 43例急性海洛因中毒患者 ,其症状缓解与催醒情况 ,呼吸恢复情况及成功率。结果 :43例急性海洛因中毒患者经纳络酮为主抢救后 ,41例成功 ,治愈率达 95 %。结论 :纳络酮抢救急性海洛因中毒 ,具有疗效好 ,见效快 ,简单易行 ,一般无副作用 ,可作为急性海洛因中毒常规首选治疗药物。     

海洛因致急性肺水肿的护理分析

目的:总结15例海洛因中毒致急性肺水肿的观察及护理。方法:回顾性分析海洛因中毒致急性肺水肿15例的临床资料。结果:15例中抢救成功率为87%(13/15),死亡率为13%(2/15)。结论:密切监测生命体征,保持呼吸道通畅,加强气道护理,预防并发症是抢救成功的关键。     

醒脑静联用纳络酮抢救急性海洛因中毒昏迷

评价醒脑静在抢救急性海洛因中毒昏迷中的作用。方法：醒脑静静脉注配合纳络酮静滴抢救急性海洛因中毒昏迷患者１１例，结果：治疗后昏迷患者呼吸抑制改善时间：１￣３分钟、４￣６分钟２例；苏醒时间１小时内８例，１￣２小时３例。结论：中药醒脑静联用纳络酮治疗海洛因中毒昏迷，可缩短呼吸抑制及苏醒时间，改善预后。     

急性海洛因中毒并肺水肿的急救治疗

通过对１６例急性海洛因中毒并肺水肿的救治分析，认为中毒致肺水肿的机制受多因素影响。治疗的原则应首先使用纳络酮解除呼吸中枢抑制，改善通气纠正缺氧，其后才是针对肺水肿的治疗，除强心利尿的常规上，还应及时使用莨菪类药物，由于莨菪类药物具有兴奋吸附中枢、扩张小动静脉减轻心脏前后负荷、解除支气管痉挛、减少呼吸道分泌物等作用，所以认为是治疗急性海洛因中毒并肺水肿的一有效药物。     

醒脑静联用纳络酮抢救急性海洛因中毒昏迷

目的：评价醒脑静在抢救急性海洛因中毒昏迷中的作用。方法：醒脑静静注配合纳络酮静滴抢救急性海洛因中毒昏迷患者１１例。结果：治疗后昏迷患者呼吸抑制改善时间：１～３分钟９例，４～６分钟２例；苏醒时间１小时内８例，１～２小时３例。结论：中药醒脑静联用纳络酮治疗海洛因中毒昏迷，可缩短呼吸抑制及苏醒时间，改善预后     

纳络酮救治急性一氧化碳中毒的疗效观察

目的：探讨纳络酮对急性一氧化碳中毒的治疗效果。方法：将50例中重度急性一氧化碳中毒患者随机分成治疗组和对照组，治疗组在常规治疗基础上加用纳络酮，对照组仅予常规治疗。结果：中、重度中毒患者应用纳络酮治疗后均较对照组催醒时间缩短（P均〈0．05）。结论：纳络酮对急性一氧化碳中毒有急救治疗作用，为抢救患者赢得宝贵时间。     

以纳络酮为主综合抢救急性海洛因中毒37例

以纳络酮为主抢救成功急性海洛因中毒37例,报告如下。1　临床资料1.1　病例:急性海洛因中毒37例中男31例,女6例;年龄16～25岁。均为静注吸毒者,吸毒时间0.5～1.0年。37例均为超既往量静注海洛因(每次注射量100～900mg)致中毒。入院前昏迷时间20分钟～15小时。临床表现:患者入院     

海洛因中毒并失血性休克23例临床护理分析

目的：探讨海洛因中毒合并失血性休克患者的治疗及护理方法。方法：采取呼吸道管理、氧疗、有效止血和扩容,以及使用纳络酮改善中毒症状。结果：23例均抢救成功后分别采用自体或人工血管移植术,术后肢体功能恢复良好。结论：综合抢救护理和血管移植是成功救治海洛因中毒合并失血性休克患者的关键。     

呼吸机治疗急性心肌梗死合并急性肺水肿18例分析

目的：探讨机械通气对急性心肌梗死合并急性肺水肿的治疗作用。方法：选择入住ICU的18例急性心肌梗死合并急性肺水肿，经常规治疗后病情不能缓解的患者给予机械通气治疗，并观察呼吸机治疗前后患者心率、动脉血PaO2、PaCO2、SaO2、pH值。结果：18例急性心肌梗死合并急性肺水肿患者抢救成功16例，抢救成功率88．9％。机械通气治疗6h后心衰症状明显缓解，动脉血PaO2、SaO2明显升高，心率减慢（P〈0．01）。结论：急性心肌梗死合并急性肺水肿时使用呼吸机正压通气治疗可迅速提高动脉血氧分压，纠正低氧血症及酸中毒。降低心脏的前、后负荷，改善心功能。     

Patterns of presentation in heroin overdose resulting in pulmonary edema

The study objective was to describe the morbidity of patients presenting with heroin overdose (HOD)-induced noncardiogenic pulmonary edema (NCPE) at an urban ED. A retrospective chart review of patients presenting between 1996 and 1999 with the diagnosis of HOD was conducted. Using a standardized data abstraction form, information on prehospital care, ED care, demographics, and cointoxications was collected. One hundred twenty-five charts (78%) were available for review. Of these, 13 (10%) were diagnosed with NCPE and all were male. In the field, NCPE patients had an average relative risk of 6, a Glasgow Coma Scale of 4, and all needed naloxone. The average admitted duration of use was 2.9 years for those who developed NCPE compared with 13.2 years for those who did not. Five (42%) NCPE patients tested positive for cocaine use and 7 (58%) tested positive for alcohol. In this cohort, the NCPE patients were male and less experienced users with initial low relative risk and Glasgow Coma Scale which demanded prehospital naloxone use. (Am J Emerg Med 2003;21:32-34.     

Do heroin overdose patients require observation after receiving naloxone?

Context: Heroin use in the US has exploded in recent years, and heroin overdoses requiring naloxone are very common. After awakening, some heroin users refuse further treatment or transport to the hospital. These patients may be at risk for recurrent respiratory depression or pulmonary edema. In those transported to the emergency department, the duration of the observation period is controversial. Additionally, non-medical first responders and lay bystanders can administer naloxone for heroin and opioid overdoses. There are concerns about the outcomes and safety of this practice as well.

Objectives: To search the medical literature related to the following questions: (1) What are the medical risks to a heroin user who refuses ambulance transport after naloxone? (2) If the heroin user is treated in the emergency department with naloxone, how long must they be observed prior to discharge? (3) How effective in heroin users is naloxone administered by first responders and bystanders? Are there risks associated with naloxone distribution programs?

Methods: We searched PubMed and GoogleScholar with search terms related to each of the questions listed above. The search was limited to English language and excluded patents and citations. The search was last updated on September 31, 2016. The articles found were reviewed for relevance to our objective questions. Eight out of 1020 citations were relevant to the first 2 questions, 5 of 707 were relevant to the third question and 15 of 287 were relevant to the fourth question. In the prehospital environment, does a heroin user revived with naloxone always require ambulance transport and what are the medical risks if ambulance transport is refused after naloxone? The eight articles were all observational studies done either prospectively or retrospectively. Two studies focused on heroin overdoses and included 1069 patients not transported to the hospital. No deaths occurred in this group. In counting the patients from all eight studies, some of which included non-heroin opioid overdoses, there were 5443 patients treated without transport and four deaths from rebound opioid toxicity. The number needed to transport to save one life (NNT) is 1361. Adverse effects were mostly related to opioid withdrawal. If a heroin user is treated in the ED, how long must the patient stay under observation before being safe for discharge? Five articles addressing the duration of ED observation required for patients treated with naloxone for opioid overdoses. Although a wide range of observation durations were reported, one study supported observing patients for one hour. If after this period the patient mobilizes as usual, has normal vital signs, and a Glasgow Coma Scale of 15, they can be discharged safely. What are the likely risks in heroin users following naloxone use by lay bystanders or first responders? Of the 15 relevant papers, a systematic review reported a 100% survival rate in eleven studies and a range of 96–99% survival in the remaining four. Two other studies suffered from poor follow-up and had lower success rates of 83% and 89%. Few if any risks were associated with opioid overdose prevention programs in which lay people were trained to administer naloxone.

Conclusions: Patients revived with naloxone after heroin overdose may be safely released without transport to the hospital if they have normal mentation and vital signs. In the absence of co-intoxicants and further opioid use there is very low risk of death from rebound opioid toxicity. For those patients treated in the ED for opioid overdose, an observation period of one hour is sufficient if they ambulate as usual, have normal vital signs and a Glasgow Coma Scale of 15. Patients suffering opioid toxicity can be administered naloxone safely by first responders and trained lay people. Programs that train these individuals are likely safe and beneficial, however further research is necessary.     

Retrospective Review of Need for Delayed Naloxone or Oxygen in Emergency Department Patients Receiving Naloxone for Heroin Reversal

BackgroundEmergency departments (EDs) are experiencing an increasing number of heroin overdose visits. Currently, there is no generally agreed upon ED observation period for heroin overdose patients who receive naloxone.ObjectivesWe aimed to determine the safety of a 2-h observation period for heroin overdose patients who receive naloxone.MethodsWe performed a chart review of all patients who presented with any opioid-related complaint between 2009 and 2014 to our urban academic trauma center. Subset analysis of patients with isolated heroin overdose who received naloxone was performed, with the intent of excluding patients intoxicated with long-acting/enteral opioids. The primary outcome was the number of patients who required delayed intervention—specifically, additional naloxone or supplemental oxygen.ResultsBetween 2009 and 2014, we recorded 806 visits to our ED for heroin use after receiving naloxone. Twenty-nine patients (3.6%) received a repeat dose of naloxone, and 17 patients (2%) received oxygen ≥2 h after initial naloxone administration. Our 2-h intervention rate was 4.6% (N = 37). This decreased to 1.9% (N = 15) after 3 h and 0.9% (N = 7) after 4 h. Patients with polysubstance use were more likely to receive repeat naloxone (p < 0.01), but not oxygen (p = 0.10). Preexisting cardiopulmonary conditions did not correlate with a need for supplemental oxygen (p = 0.24) or repeat naloxone (p = 0.30).ConclusionsA 2-h ED observation period for heroin overdose patients reversed with naloxone resulted in a delayed intervention rate of 5%. Clinicians may consider a 3-h observation period, with extra scrutiny in polysubstance abuse.     

Out-of-hospital Treatment of Opioid Overdoses in an Urban Setting

Objectives : To investigate clinical outcomes in a cohort of opioid overdose patients treated in an out-of-hospital urban setting noted for a high prevalence of IV opioid use. Methods : A retrospective review was performed of presumed opioid overdoses that were managed in 1993 by the emergency medical services (EMS) system in a single-tiered, urban advanced life support (ALS) EMS system. Specifically. all patients administered naloxone by the county paramedics were reviewed. Those patients with at least 3 of 5 objective criteria of an opioid overdose [respiratory rate <6/min, pinpoint pupils, evidence of IV drug use, Glasgow Coma Scale (GCS) score <12, or cyanosis] were included. A response to naloxone was defined as improvement to a GCS 14 and a respiratory rate 10/min within 5 minutes of naloxone administration. ED dispositions of opioid-overdose patients brought to the county hospital were reviewed. All medical examiner's cases deemed to be opioid-overdose-related deaths by postmortem toxicologic levels also were reviewed. Results : There were 726 patients identified with presumed opioid overdoses. Most patients (609/726, 85.4%) had an initial pulse and blood pressure (BP). Most (94%) of this group responded to naloxone and all were transported. Of the remainder, 101 (14%) had obvious signs of death and 16 (2.2%) were in cardiopulmonary arrest without obvious signs of death. Of the patients in full arrest, 2 had return of spontaneous circulation but neither survived. Of the 609 patients who had initial BPs, 487 (80%) received naloxone IM (plus bag-valve-mask ventilation) and 122 (20%) received the drug IV. Responses to naloxone were similar; 94% IM vs 90% IV. Of 443 patients transported to the county hospital, 12 (2.7%) were admitted. The admitted patients had noncardiogenic pulmonary edema (n = 4). pneumonia (n = 2), other infections (n = 2), persistent respiratory depression (n = 2). and persistent alteration in mental status (n = 2). The patients with pulmonary edema were clinically obvious upon ED arrival. Hypotension was never noted and bradycardia was seen in only 2% of our presumed-opioid:overdose population. Conclusions : The majority of the opioid-overdose patients who had initial BPs responded readily to naloxone, with few patients requiring admission. Noncardiogenic pulmonary edema was uncommon and when present, hypoxia was evident upon arrival to the ED. Naloxone administered IM in conjunction with bag-valve-mask ventilation was effective in this patient population. The opioid-overdose patients in cardiopulmonary arrest did not survive.     

Noncardiogenic pulmonary edema after charcoal hemoperfusion

Hemoperfusion over cellulose-coated activated charcoal was used to treat a patient with severe doxepin overdose. Noncardiogenic pulmonary edema (NCPE) developed temporally in relation to the procedure. In this case, NCPE may have been from complement activation by the cellulose-coated charcoal column.     

Challenges with take-home naloxone in reducing heroin mortality: a review of fatal heroin overdose cases in Victoria,Australia

Aim: Take-home naloxone (THN) programs have been implemented in order to reduce the number of heroin-overdose deaths. Because of recent legislative changes in Australia, there is a provision for a greater distribution of naloxone in the community, however, the potential impact of these changes for reduced heroin mortality remains unclear. The aim of this study was to examine the characteristics of the entire cohort of fatal heroin overdose cases and assess whether there was an opportunity for bystander intervention had naloxone been available at the location and time of each of the fatal overdose events to potentially avert the fatal outcome in these cases.

Methods: The circumstances related to the fatal overdose event for the cohort of heroin-overdose deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated. Coronial data were investigated for all cases and data linkage was performed to additionally investigate the Emergency Medical Services information about the circumstances of the fatal heroin overdose event for each of the decedents.

Results and Discussion: There were 235 fatal heroin overdose cases identified over the study period. Data revealed that the majority of fatal heroin overdose cases occurred at a private residence (n?=?186, 79%) and where the decedent was also alone at the time of the fatal overdose event (n?=?192, 83%). There were only 38 cases (17%) where the decedent was with someone else or there was a witness to the overdose event, and in half of these cases the witness was significantly impaired, incapacitated or asleep at the time of the fatal heroin overdose. There were 19 fatal heroin overdose cases (8%) identified where there was the potential for appropriate and timely intervention by a bystander or witness.

Conclusion: This study demonstrated that THN introduction alone could have led to a very modest reduction in the number of fatal heroin overdose cases over the study period. A lack of supervision or a witness to provide meaningful and timely intervention was evident in most of the fatal heroin overdose cases.     

Assessment for Deaths in Out-of-hospital Heroin Overdose Patients Treated with Naloxone Who Refuse Transport

Naloxone frequently is used to treat suspected heroin and opioid overdoses in the out-of-hospital setting. The authors' emergency medical services system has operated a policy of allowing these patients, when successfully treated, to sign out against medical advice (AMA) in the field. OBJECTIVES: To evaluate the safety of this AMA policy. METHODS: This is a retrospective review of out-of-hospital and medical examiner (ME) databases over a five-year period. The authors reviewed all ME cases in which opioid overdoses were listed as contributing to the cause of death. These cases were cross-compared with all patients who received naloxone by field paramedics and then refused transport. The charts were reviewed by dates, times, age, sex, location, and ethnicity when available. RESULTS: There were 998 out-of-hospital patients who received naloxone and refused further treatment and 601 ME cases of opioid overdose deaths. When compared by age, time, date, sex, location, and ethnicity, there were no cases in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opioid overdose. CONCLUSIONS: Giving naloxone to patients with heroin overdoses in the field and then allowing them to sign out AMA resulted in no identifiable deaths within this study population.     

Adverse events after naloxone treatment of episodes of suspected acute opioid overdose.

OBJECTIVE: An increasing and serious heroin overdose problem in Oslo has mandated the increasing out-of-hospital use of naloxone administered by paramedics. The aim of this study was to determine the frequencies and characteristics of adverse events related to this out-of-hospital administration by paramedics. METHODS: A one-year prospective observational study from February 1998 to January 1999 was performed in patients suspected to be acutely overdosed by an opioid. A total of 1192 episodes treated with naloxone administered by the Emergency Medical Service system in Oslo, were included. The main outcome variable was adverse events observed immediately after the administration of naloxone. RESULTS: The mean age of patients included was 32.6 years, and 77% were men. Adverse events suspected to be related to naloxone treatment were reported in 45% of episodes. The most common adverse events were related to opioid withdrawal (33%) such as gastrointestinal disorders, aggressiveness, tachycardia, shivering, sweating and tremor. Cases of confusion/restlessness (32%) might be related either to opioid withdrawal or to the effect of the heroin in combination with other drugs. Headache and seizures (25%) were probably related to hypoxia. Most events were non-serious. In three episodes (0.3%) the patients were hospitalized because of adverse events. CONCLUSION: Although adverse events were common among patients treated for opioid overdose in an out-of-hospital setting, serious complications were rare. Out-of-hospital naloxone treatment by paramedics seems to save several lives a year without a high risk of serious complications.