Glasgow Coma Scale in acute poisonings before and after use of antidote in patients with history of use of psychotropic agents.

INTRODUCTION: 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). CONCLUSION: 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.

Aetiological and demographical characteristics of acute poisoning in the Celje region, Slovenia.

BACKGROUND: Data on emergency treatment of poisonings are scarce. OBJECTIVE: To determine the annual rate of poisoning-related emergency medical services (EMS) interventions and to determine the aetiology and demographic characteristics of poisoning cases. 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: Two hundred and forty-four poisoning-related EMS interventions were recorded among a total of 4486 interventions (5.4%) corresponding to an average annual rate of 0.56 poisonings per 1000 inhabitants per year. Psychoactive agents were detected in 56.5% of the cases. Two-thirds of the poisonings took place outside patients' home. In 30% of the cases, the administration of poison was because of suicidal intentions. The most common substance ingested was alcohol alone or in combination with prescription or illegal drugs in 42.6% of cases, followed by drugs alone or in combination with alcohol in 39.2% cases. More than one-fifth of the poisonings were because of the use of illegal drugs. At the time of the arrival of EMS 23.5% of the patients were in coma. EMS applied antidote in 23.2% of the patients. After emergency care, 9.3% of the patients were still in coma, 15.6% were comatose, 26.6% were somnolent, 18.6% were disoriented and 30% had complete consciousness. Of these, 84.4% of the patients were admitted to hospital or specialized care and 15.6% were sent back home. CONCLUSION: The pattern of poisoning is contrasted with that in other countries. The EMS proved to be a valuable resource for treatment of acute poisoning.