美国和加拿大目前还没有正式公布的全国毒物信息专家指南或对乙酰氨基酚中毒管理急诊部门指南。导致管理上的显著差异。
■制定美国和加拿大对乙酰氨基酚中毒管理的共识指南。
■四个临床毒理学学会(美国毒物中心,美国临床毒理学会,美国医学毒理学学院,和加拿大毒物控制中心协会)选择的参与者(n=21)。由一位无投票权的主席领导,使用改进的德尔菲法,该小组创建了一个决策框架,并确定了对乙酰氨基酚中毒患者的适当临床治疗.这项工作的独特之处在于,除了系统收集和审查医学文献外,还收集了大多数毒物中心的指南。在准则定稿之前,外部组织的审查意见已被纳入。该项目于2021年3月开始,并于2023年3月结束。
■搜索检索到84个指南和278个出版物。小组制定了单次或重复摄入对乙酰氨基酚的急诊科管理指南。此外,小组讨论了缓释制剂,高风险摄入,服用抗胆碱能药或阿片类药物,年龄小于6岁,怀孕,重量大于100公斤,和静脉注射对乙酰氨基酚。与当前美国实践的差异包括将急性摄入定义为开始过量后4至24小时的摄入表现。开发了Rumack-Matthew列线图的修订形式。术语“大量摄入”被术语“高风险摄入”代替,并用特定的列线图表示。其他建议包括急诊科分诊的具体标准,实验室评估和监测参数,定义胃肠去污的作用,乙酰半胱氨酸治疗的详细管理,相关的不利影响,停止乙酰半胱氨酸治疗的标准,以及与临床毒理学家协商的标准。最后,具体的治疗考虑因素,包括乙酰半胱氨酸剂量,Fomepizole给药,以及体外消除和移植评估的考虑,已解决。
■这项定性研究就一致的循证医学建议提供了共识声明,药房,和护理教育和实践,以优化对乙酰氨基酚中毒患者的护理。
The US and Canada currently have no formal published nationwide guidelines for specialists in poison information or emergency departments for the management of acetaminophen poisoning, resulting in significant variability in management.
To develop
consensus guidelines for the management of
acetaminophen poisoning in the US and Canada.
Four clinical toxicology societies (America\'s Poison Centers, American Academy of Clinical Toxicology, American College of Medical Toxicology, and Canadian Association of Poison Control Centers) selected participants (n = 21). Led by a nonvoting chairperson using a modified Delphi method, the panel created a decision framework and determined the appropriate clinical management of a patient with acetaminophen poisoning. Unique to this effort was the collection of guidelines from most poison centers in addition to systematic collection and review of the medical literature. Comments from review by external organizations were incorporated before the
guideline was finalized. The project began in March 2021 and ended in March 2023.
The search retrieved 84
guidelines and 278 publications. The panel developed guidelines for emergency department management of single or repeated ingestion of
acetaminophen. In addition, the panel addressed extended-release formulation, high-risk ingestion, coingestion of anticholinergics or opioids, age younger than 6 years, pregnancy, weight greater than 100 kg, and intravenous acetaminophen use. Differences from current US practice include defining acute ingestion as an ingestion presentation from 4 to 24 hours after overdose was initiated. A revised form of the Rumack-Matthew nomogram was developed. The term massive ingestion was replaced with the term high-risk ingestion and denoted by a specific nomogram line. Other recommendations include specific criteria for emergency department triage, laboratory evaluation and monitoring parameters, defining the role of gastrointestinal decontamination, detailed management of acetylcysteine treatment, associated adverse effects, and stopping criteria for acetylcysteine treatment, as well as criteria for consultation with a clinical toxicologist. Finally, specific treatment considerations, including acetylcysteine dosing, fomepizole administration, and considerations for extracorporeal elimination and transplant evaluation, were addressed.
This qualitative study provides a
consensus statement on consistent evidence-based recommendations for medical, pharmacy, and nursing education and practice to optimize care of patients with acetaminophen poisoning.