Home observation, obesity, poor ventilation and other basic diseases should be told to keep warm, lie on your side, prevent complications such as vomiting and aspiration, and those with severe Disulfiram-like awakening reaction should be treated as soon as possible.
(2) Measures to promote alcohol excretion in digestive tract
Because of the rapid absorption of alcohol, vomiting, gastric lavage and activated carbon are not suitable for patients with simple alcoholism. Gastric lavage should evaluate the condition and weigh the advantages and disadvantages. Suggestions are limited to one of the following situations: ① There is no vomiting within 2 hours after drinking, and the coma patients whose condition may deteriorate are evaluated; (2) coexistence with other drugs or poisons or high suspicion of poisoning; ③ The gastric tube has been indwelling, especially in patients with coma and shock. The gastric tube can be used for artificial gastric lavage.
(3) drug therapy
Metadoxine is a drug to promote alcohol metabolism and an activator of acetaldehyde dehydrogenase, which can antagonize the decrease of alcohol dehydrogenase (ADH) activity caused by acute and chronic alcoholism. It can accelerate the excretion of ethanol and its metabolites acetaldehyde and ketone bodies, and belongs to drugs for promoting alcohol metabolism.
Metadoxine can resist the decrease of ATP and intracellular reduced glutathione (GSH) caused by acute alcoholism, maintain the balance of antioxidant system in the body, antagonize the oxidative stress caused by acute and chronic alcoholism, and improve the liver function damage caused by drinking and the psychological and behavioral abnormalities caused by alcoholism. Metadoxine can be used for patients with moderate and severe alcoholism, especially those with aggressive behavior and emotional abnormalities.
0.9g/ time, given by intravenous drip, forbidden for lactating patients and patients with bronchial asthma, and there is no reliable data for children's application. Proper rehydration and vitamin B 1, B6 and C are beneficial to the oxidative metabolism of alcohol.
② Naloxone, a sober drug, can specifically antagonize various effects mediated by endogenous morphine-like substances. Some foreign studies doubt its curative effect on acute alcoholism. But experts in this field believe that naloxone can relieve the central inhibition of alcoholism and shorten the coma time. The difference of curative effect may be related to ethnic differences and dosage.
It is suggested that the first dose of moderate poisoning should be 0.4~0.8mg plus 10~20mL normal saline and injected intravenously; Repeat the dose if necessary; In severe poisoning, the first dose of 0.8~ 1.2mg plus 20mL of normal saline was injected intravenously. After 30 minutes, it can be repeated 1 time, or 2mg plus 5% glucose or physiological saline in 500mL, and injected intravenously or by micropump at a speed of 0.4mg/h until consciousness is awake.
Namephen hydrochloride is a long-acting opioid receptor antagonist with high selectivity and specificity, and it has good therapeutic effect in theory. It has been reported that it is used in acute alcoholism, but more clinical research is needed to evaluate its therapeutic effect and application method in acute alcoholism.
③ Sedatives should be used with caution in acute alcoholism. Diazepam can be used in cases of irritability or overexcitation. Intramuscular injection is safer than intravenous injection. Pay attention to breathing and blood pressure. The first generation antipsychotic drugs such as haloperidol are the first choice for manic patients, and the second generation such as olanzapine should also be a feasible choice. Oral administration is safer than intravenous injection. Avoid chlorpromazine, morphine and phenobarbital sedatives.
④ Gastric mucosal protective agent: Patients with severe poisoning can routinely use gastric mucosal H2 receptor antagonists or proton pump inhibitors, especially those with obvious digestive tract symptoms. Proton pump inhibitors may have a better protective effect on gastric mucosa.
(4) Blood purification therapy and indications:
Alcohol is soluble in water and has strong lipophilicity. It is controversial that hemoperfusion can remove ethanol from the body. Hemodialysis can directly and quickly remove ethanol and its metabolites from blood. It is suggested that hemodialysis should be the first choice when necessary, and continuous bedside hemofiltration (CRRT) is also a feasible choice, but it is expensive. Blood purification treatment is feasible if the condition is critical or worsens after routine treatment, and in any of the following circumstances.
① Blood alcohol content exceeds 87 mmol/L (400 m dl); ② Deep coma with severe respiratory and circulatory depression; ③ acidosis (pH 7. 2) with shock; ④ Acute renal insufficiency caused by severe poisoning; ⑤ If poisoning or other poisoning is highly suspected to be life-threatening, the blood purification method should be selected as appropriate according to the characteristics of poisons.
(5) Application of antibiotics:
There is no indication to use antibiotics to treat simple acute alcoholism unless there is clear evidence of concurrent infection, such as vomiting and aspiration leading to lung infection. Note that the use of antibiotics can induce disulfiram-like reactions, among which cephalosporins are the most common among β-lactams, cefoperazone is the most common, and others are metronidazole and furazolidone, so it is advisable to stay in hospital for observation during medication.
(6) Symptomatic and supportive treatment
The airway and ventilation function should be evaluated in patients with lethargy and coma, and tracheal intubation is necessary. To do a good job in patient safety protection, if necessary, give appropriate protection and restraint to those who are agitated or excited, pay attention to keeping warm, lie on the side of the coma to prevent catching cold and heatstroke, and use bed bars to prevent accidents. Maintain the balance of water, electrolyte and acid-base, correct hypoglycemia and brain edema, give dehydrating agent, and apply traditional Chinese medicine Xingnaojing.
5. Matters needing attention in emergency handling
In the diagnosis and treatment of acute alcoholism, we should not only avoid delaying diagnosis and treatment due to insufficient evaluation of the condition, but also avoid excessive medical treatment and waste of resources. Third-class hospitals should have special sober-up observation rooms to meet the clinical needs of the increasing number of acute alcoholism cases.
(1) Indications for hospitalization observation:
Hospitalization observation or hospitalization is suitable for patients with moderate and severe poisoning.
(2) Reasonable application of auxiliary inspection:
For moderate and severe poisoning, blood electrolyte and glucose concentration should be routinely checked. If conditions permit, it is feasible to carry out blood gas analysis and determine the alcohol concentration in blood or exhaled gas. Those with basic diseases or complications should be examined accordingly.
In general, head CT examination should be carried out under the following circumstances:
① Coma patients who have a history of head trauma but can't explain the specific situation in detail; ② those who show signs of neurolocalization after drinking; ③ The alcohol consumption or alcohol concentration is inconsistent with the disturbance of consciousness; ④ After routine treatment such as naloxone to wake up for 2 hours, the state of consciousness did not improve, but worsened.
Patients with acute alcoholism who are unconscious or unable to accurately describe their medical history should have routine electrocardiogram examination, especially those with previous heart disease history or high-risk factors, and be reexamined when necessary.
(3) Precautions for pre-hospital first aid:
Pre-hospital first aid should pay attention to the incidence of acute alcohol and study countermeasures. (1) When answering the call for help of acute alcoholism, ask the patient whether he is conscious or not, and whether he is accompanied by vomiting; (2) In case of vomiting, the personnel present should be instructed to change the patient's position so that the head leans to one side. & lt Avoid suffocation except mouth contents; (3) In case of unconsciousness and cardiac arrest, the patient's family members and witnesses should be instructed to keep the patient's respiratory tract unobstructed and perform cardiopulmonary resuscitation.
On-site treatment and transportation should closely observe vital signs, pay attention to airway patency, maintain respiratory and circulatory functions, and learn as much as possible about the injury history of drunk traffic accidents. The occupation of pre-hospital emergency resources by alcoholics should attract social attention.
(4) Education:
In view of the increase of alcohol abuse and the effect of emergency intervention, emergency medical staff should take the harm of alcohol and abstinence education as part of their work. According to the different psychological conditions of patients, communicate with patients and their caregivers in time, carry out health education, and publicize the harm of alcoholism to patients and their families after patients are awake and emotionally stable. Medical staff should protect themselves and pay attention to safety when receiving medical treatment.