Annales françaises de médecine d'urgence

, Volume 3, Issue 2, pp 95–102 | Cite as

Prise en charge préhospitalière des intoxications aiguës graves

Mise au Point / Update

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.

Mots clés

Urgences préhospitalières Intoxication Antidote 

Severe poisoning management in the prehospital setting

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.

Keywords

Emergency Prehospital Poisoning Antidote 

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Copyright information

© Société française de médecine d'urgence and Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Pôle urgences Samu-Smur toxicologieCHU MichalonGrenoble cedex 09France

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