Skip to main content
SpringerLink
Log in

Prise en charge préhospitalière des intoxications aiguës graves

Severe poisoning management in the prehospital setting

  • Mise au Point / Update
  • Published:
Annales françaises de médecine d'urgence

Résumé

Les intoxications sont un motif fréquent d’appel au centre 15 et d’intervention médicale préhospitalière. Il n’existe pas de consensus en matière de régulation médicale des intoxications et, en dehors des situations où la détresse vitale est patente, le médecin régulateur doit s’appuyer sur l’analyse de l’anamnèse toxicologique. Certaines substances ont une gravité potentielle qui justifie l’envoi immédiat de secours médicalisés tandis que les notions de dose supposée ingérée et de délai depuis l’ingestion sont également des facteurs à prendre en compte. En revanche, le médecin régulateur ne peut pas fonder son raisonnement clinique uniquement sur les signes vitaux, car ils sont insuffisants à eux seuls pour déterminer le pronostic. Concernant la prise en charge préhospitalière des intoxications, le patient doit bénéficier avant tout d’un traitement symptomatique. Cependant, l’utilisation ciblée d’antidotes peut s’avérer indispensable dès la phase préhospitalière, et les médecins urgentistes doivent être sensibilisés à certaines techniques d’exception telles que l’assistance circulatoire périphérique dans les intoxications graves aux cardiotoxiques. Par ailleurs, le potentiel évolutif des symptômes liés à l’intoxication doit inciter le médecin urgentiste à la prudence quant à l’orientation du patient. Enfin, la mise en place de filières de soins est indispensable pour une prise en charge préhospitalière adaptée des patients.

Abstract

Acute poisonings frequently lead to emergency calls and to a medical intervention in a pre-hospital setting. There is no consensus concerning the medical dispatching of poisoned patients. Except for persons presenting with life-threatening outcomes, the patient’s toxicological history should be carefully analyzed to help the dispatching. When ingested, some substances may induce potentially severe outcomes that require to be immediately managed by a medical team. The supposed ingested dose and the delay since ingestion are decision-helping factors that should also be taken into account. For the dispatching, the medical dispatcher cannot only rely on the patient’s vital signs as they, alone, cannot help determine any prognosis. Patients initially managed in a pre-hospital setting should first receive a symptomatic treatment. However, in some cases, antidotes may be required in the pre-hospital setting and emergency physicians should be aware of the usefulness of special techniques like extracorporeal life support for acute poisonings with cardiotoxic drugs. Symptoms of poisonings usually progress rapidly and emergency physicians should decide where to dispatch patients rather cautiously. Eventually, it seems necessary to implement specific care pathways to better adapt pre-hospital management and admission to hospital of some patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Heyerdahl F, Hovda KE, Bjornaas MA, et al (2008) Pre-hospital treatment of acute poisonings in Oslo. BMC Emerg Med 8:15

    Article  PubMed  Google Scholar 

  2. Maloney GE Jr, Pakiela JA (2008) Characteristics of patients transported by an aeromedical service for acute toxicologic emergencies: a 5-year experience. Air Med J 27:48–50

    Article  PubMed  Google Scholar 

  3. Labourel H, Ladwig M, Maurin C, et al (2006) Analyse épidémiologique des intoxications médicamenteuses volontaires aiguës: prise en charge par un service mobile d’urgence et de réanimation. Rev Med Liege 61:185–9

    PubMed  CAS  Google Scholar 

  4. Ould-Ahmed M, Drouillard I, Savio C, et al (1999) Intoxications aiguës prises en charge par un service mobile d’urgence et de réanimation: description rétrospective de 361 cas. Réanimation 8:93–97

    Google Scholar 

  5. Nelson LS, Erdman AR, Booze LL, et al (2007) Selective serotonin reuptake inhibitor poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 45:315–32

    Article  CAS  Google Scholar 

  6. Dart RC, Erdman AR, Olson KR, et al (2006) Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 44:1–18

    CAS  Google Scholar 

  7. Wax PM, Erdman AR, Chyka PA, et al (2005) Beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 43:131–46

    CAS  Google Scholar 

  8. Olson KR, Erdman AR, Woolf AD, et al (2005) Calcium channel blocker ingestion: an evidence-based consensus guideline for out-of- hospital management. Clin Toxicol (Phila) 43:797–822

    Article  CAS  Google Scholar 

  9. Woolf AD, Erdman AR, Nelson LS, et al (2007) Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 45:203–33

    Article  CAS  Google Scholar 

  10. Manoguerra AS, Erdman AR, Woolf AD, et al (2008) Valproic acid poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 46:661–76

    Article  CAS  Google Scholar 

  11. Cobaugh DJ, Erdman AR, Booze LL, et al (2007) Atypical antipsychotic medication poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 45:918–42

    Article  Google Scholar 

  12. Chyka PA, Erdman AR, Christianson G, et al (2007) Salicylate poisoning: an evidence-based consensus guideline for out-of- hospital management. Clin Toxicol (Phila) 45:95–131

    Article  CAS  Google Scholar 

  13. Mégarbane B, Donetti L, Blanc T, et al (2006) Intoxications graves par médicaments et substances illicites en réanimation. Réanimation 15:332–42

    Article  Google Scholar 

  14. Lardeur JY, Compain C, Baudier D, Baudier A (2001) Régulation et prise en charge des intoxications volontaires par un service d’aide médicale d’urgence. Presse Med 30:626–30

    PubMed  CAS  Google Scholar 

  15. Giroud M (2009) La régulation médicale en médecine d’urgence. Réanimation 18:737–41

    Article  Google Scholar 

  16. Schwake L, Wollenschläger I, Stremmel W, Encke J (2009) Adverse drug reactions and deliberate self-poisoning as cause of admission to the intensive care unit: a 1-year prospective observational cohort study. Intensive Care Med 35:266–74

    Article  PubMed  Google Scholar 

  17. Liisanantti JH, Ohtonen P, Kiviniemi O, et al (2011) Risk factors for prolonged intensive care unit stay and hospital mortality in acute drug-poisoned patients: an evaluation of the physiologic and laboratory parameters on admission. J Crit Care 26:160–5

    Article  PubMed  Google Scholar 

  18. Bronstein AC, Spyker DA, Cantilena LR Jr, et al (2011) 2010 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 28th Annual Report. Clin Toxicol (Phila) 49:910–41

    Article  Google Scholar 

  19. Heyerdahl F, Bjornas MA, Hovda KE, et al (2008) Acute poisonings treated in hospitals in Oslo: a one-year prospective study (II): clinical outcome. Clin Toxicol (Phila) 46:42–9

    Article  CAS  Google Scholar 

  20. Novack V, Jotkowitz A, Delgado J, et al (2006) General characteristics of hospitalized patients after deliberate self-poisoning and risk factors for intensive care admission. Eur J Intern Med 17:485–9

    Article  PubMed  Google Scholar 

  21. Christ A, Arranto CA, Schindler C, et al (2006). Incidence, risk factors, and outcome of aspiration pneumonitis in ICU overdose patients. Intensive Care Med 32:1423–7

    Article  PubMed  Google Scholar 

  22. Masson R, Colas V, Parienti JJ, et al (2012) A comparison of survival with and without extracorporeal life support treatment for severe poisoning due to drug intoxication. Resuscitation 83:1413–7

    Article  PubMed  Google Scholar 

  23. Mégarbane B, Deye N, Baud FJ (2009) Assistance circulatoire périphérique au cours des intoxications aiguës par cardiotropes. Réanimation 18:428–38

    Article  Google Scholar 

  24. Daubin C, Lehoux P, Ivascau C, et al (2009) Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases. Crit Care 13:R138

    Article  PubMed  Google Scholar 

  25. Satar S, Topal M, Kozaci N (2004) Ingestion of caustic substances by adults. Am J Ther 11:258–61

    Article  PubMed  Google Scholar 

  26. Bismuth C, Scherrmann JM, Garnier R, et al (1986) Elimination of paraquat. Dev Toxicol Environ Sci 12:347–56

    PubMed  CAS  Google Scholar 

  27. Heyman EN, LoCastro DE, Gouse LH, et al (1996) Intentional drug overdose: predictors of clinical course in the intensive care unit. Heart Lung 25:246–52

    Article  PubMed  CAS  Google Scholar 

  28. Clot S, Pommier P, Debaty G, et al (2012) Critères de transfert en réanimation des intoxications médicamenteuses volontaires admises aux urgences. Congrès Urgences, Paris http://www.sfmu.org/urgences2012/urgences2012/donnees/communications/resume/resume_435.htm(accès le 9 janvier 2013)

  29. Novack V, Jotkowitz AB, Delgado J, et al (2005) Deliberate self-poisoning with acetaminophen: a comparison with other medications. Eur J Inter Med 16:585–9

    Article  Google Scholar 

  30. Lee P, Tai DY (2001) Clinical features of patients with acute organophosphate poisoning requiring intensive care. Intensive Care Med 27:694–9

    Article  PubMed  CAS  Google Scholar 

  31. Eizadi-Mood N, Sabzghabaee AM, Yadegarfar G, et al (2011) Glasgow coma scale and its components on admission: are they valuable prognostic tools in acute mixed drug poisoning? Crit Care Res Pract 1–5

  32. Leveau P (1994) Le score ETC: indice de gravité des appels pour intoxication médicamenteuse volontaire: étude prospective multicentrique. JEUR 7:132–8

    Google Scholar 

  33. Casey PB, Dexter EM, Michell J, Vale JA (1998) The prospective value of the IPCS/EC/EAPCCT Poisoning Severity Score in Cases of Poisoning. J Toxicol Clin Toxicol 36:215–7

    Article  PubMed  CAS  Google Scholar 

  34. Sam KG, Kondabolu K, Pati D, et al (2009) Poisoning severity score, APACHE II and GCS: effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. J Forensic Leg Med 16:239–47

    Article  PubMed  Google Scholar 

  35. Manini AF, Nelson LS, Skolnick AH, et al (2010) Electrocardiographic predictors of adverse cardiovascular events in suspected poisoning. J Med Toxicol 6:106–15

    Article  PubMed  Google Scholar 

  36. Waring WS, Graham A, Gray J, et al (2010) Evaluation of a QT nomogram for risk assessment after antidepressant overdose. Br J Clin Pharmacol 70:881–5

    Article  PubMed  CAS  Google Scholar 

  37. Duncan R, Thakore S (2009) Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department. J Emerg Med 37:451–5

    Article  PubMed  Google Scholar 

  38. Adnet F, Baud F (1996) Relation between Glasgow Coma Scale and aspiration pneumonia. Lancet 348:123–4

    Article  PubMed  CAS  Google Scholar 

  39. Megarbane B, Be Hong T, Kania R, et al (2010) Early laryngeal injury and complications because of endotracheal intubation in acutely poisoned patients: a prospective observational study. Clin Toxicol (Phila) 48:331–6

    Article  Google Scholar 

  40. Isbister GK, Dawson AH, Whyte IM (2003) Feasibility of prehospital treatment with activated charcoal: who could we treat, who should we treat? Emerg Med J 20:375–8

    Article  PubMed  CAS  Google Scholar 

  41. Lapostolle F, Haouache H, Ruscev M, et al (2009) Quelle place pour le charbon activé en préhospitalier ? Med Urg 31:157–8

    Google Scholar 

  42. Riou B, Barriot P, Rimailho A, Baud FJ (1998) Treatment of severe chloroquine poisoning. N Engl J Med 318:1–6

    Article  Google Scholar 

  43. Engebretsen KM, Kaczmarek KM, Morgan J, Holger JS (2011) High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila) 49:277–83

    Article  CAS  Google Scholar 

  44. Kalam Y, Graudins A (2012) Levosimendan does not improve cardiac output or blood pressure in a rodent model of propranolol toxicity when administered using various dosing regimens. Int J Toxicol 31:166–74

    Article  PubMed  CAS  Google Scholar 

  45. Cave G, Harvey M, Graudins A (2011) Intravenous lipid emulsion as antidote: a summary of published human experience. Emerg Med Australas 23:123–41

    Article  PubMed  Google Scholar 

  46. Riou B, Adnet F, Baud F, et al (2009) Recommandations sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires. Ann Fr Anesth Reanim 28:182–6

    Article  Google Scholar 

  47. Lebreton G, Pozzi M, Luyt CE, et al (2011) Out-of-hospital extra-corporeal life support implantation during refractory cardiac arrest in a half-marathon runner. Resuscitation 82:1239–42

    Article  PubMed  Google Scholar 

  48. Arlt M, Philipp A, Voelkel S, et al (2011) Out-of-hospital extracorporeal life support for cardiac arrest-A case report. Resuscitation 82:1243–5

    Article  PubMed  CAS  Google Scholar 

  49. Dehours E, Mari A, Gandia P, et al (2011) Défaillance cardiaque secondaire à une intoxication volontaire à la chloroquine: à propos d’un cas. Ann Fr Med Urgence 1:352–4

    Article  Google Scholar 

  50. Vivien B, Deye N, Mégarbane B, et al (2010) Extracorporeal life support in a case of fatal flecainide and betaxolol poisoning allowing successful cardiac allograft. Ann Emerg Med 56:409–12

    Article  PubMed  Google Scholar 

  51. Bradberry SM (2003) Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue. Toxicol Rev 22:13–27

    Article  PubMed  CAS  Google Scholar 

  52. Ruscev M, Adnet F, Gamand P, et al (2009) Accessibilité des antidotes en urgence. Presse Med 38:1861–2

    Article  PubMed  Google Scholar 

  53. Lapostolle F, Alayrac L, Adnet F, et al (2001) Disponibilité des antidotes dans l’aide médicale urgente. Presse Med 30:159–62

    PubMed  CAS  Google Scholar 

  54. Borron SW, Baud FJ, Barriot P, et al (2007) Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation. Ann Emerg Med 49:794–801

    Article  PubMed  Google Scholar 

  55. Fortin JL, Giocanti JP, Ruttimann M, Kowalski JJ (2006) Prehospital administration of hydroxocobalamin for smoke inhalation-associated cyanide poisoning: 8 years of experience in the Paris Fire Brigade. Clin Toxicol (Phila) 44(Suppl 1):37–44

    Article  CAS  Google Scholar 

  56. Lapostolle F, Borron SW, Verdier C, et al (2008) Digoxin-specific Fab fragments as single first-line therapy in digitalis poisoning. Crit Care Med 36:3014–8

    Article  PubMed  CAS  Google Scholar 

  57. Boels D, Hamel JF, Bretaudeau Deguigne M, Harry P (2012) European viper envenomings: assessment of ViperfavTM and other symptomatic treatments. Clin Toxicol (Phila) 50:189–96

    Article  CAS  Google Scholar 

  58. Cardoso LT, Grion CM, Matsuo T, et al (2011) Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care 15:R28

    Article  PubMed  Google Scholar 

  59. Chalfin DB, Trzeciak S, Likourezos A, et al (2007) Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med 35:1477–83

    Article  PubMed  Google Scholar 

  60. Palmer M, Hoffman RS, White AB (2007) A,B,Cs of caustic ingestions in suicidal adults. Ann Emerg Med 49:246–7

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pôle urgences Samu-Smur toxicologie, CHU Michalon, BP 217, F-38043, Grenoble cedex 09, France

    M. Maignan & V. Danel

Authors
  1. M. Maignan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Danel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Danel.

About this article

Cite this article

Maignan, M., Danel, V. Prise en charge préhospitalière des intoxications aiguës graves. Ann. Fr. Med. Urgence 3, 95–102 (2013). https://doi.org/10.1007/s13341-013-0291-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13341-013-0291-4

Mots clés

Keywords

Search

Navigation