RESUMEN
Intravenous lipid emulsion (ILE) has been used widely for the treatment of poisoning due to local anesthetic agent and is increasingly reported as a therapy for other forms of poisoning. This article will review the proposed mechanisms of action for ILE in poisoning and the evidence from animal studies and human experience supporting the use of ILE for poisoning due to nonlocal anesthetic agents.
Asunto(s)
Anestésicos Locales/envenenamiento , Antídotos/uso terapéutico , Emulsiones Grasas Intravenosas/uso terapéutico , Animales , Antídotos/administración & dosificación , Emulsiones Grasas Intravenosas/efectos adversos , Humanos , LípidosRESUMEN
STUDY OBJECTIVE: Intravenous (IV) prochlorperazine with diphenhydramine is superior to subcutaneous sumatriptan in the treatment of migraine patients presenting to the emergency department (ED). METHODS: In this randomized, double-blind, placebo-controlled trial, after providing written informed consent, patients presenting to the ED with a chief complaint of migraine received a 500-mL bolus of IV saline solution and either 10 mg prochlorperazine with 12.5 mg diphenhydramine IV plus saline solution placebo subcutaneously or saline solution placebo IV plus 6 mg sumatriptan subcutaneously. Pain intensity was assessed with 100-mm visual analog scales (visual analog scale at baseline and every 20 minutes for 80 minutes). The primary outcome was change in pain intensity from baseline to 80 minutes or time of ED discharge if subjects remained in the ED for fewer than 80 minutes after treatment. Sedation and nausea were assessed every 20 minutes with visual analog scale scales, and subjects were contacted within 72 hours to assess headache recurrence. RESULTS: Sixty-eight subjects entered the trial, with complete data for 66 subjects. Baseline pain scores were similar for the prochlorperazine/diphenhydramine and sumatriptan groups (76 versus 71 mm). Mean reductions in pain intensity at 80 minutes or time of ED discharge were 73 mm for the prochlorperazine/diphenhydramine group and 50 mm for those receiving sumatriptan (mean difference 23 mm; 95% confidence interval 11 to 36 mm). Sedation, nausea, and headache recurrence rates were similar. CONCLUSION: IV prochlorperazine with diphenhydramine is superior to subcutaneous sumatriptan in the treatment of migraine.
Asunto(s)
Analgésicos/uso terapéutico , Trastornos Migrañosos/tratamiento farmacológico , Proclorperazina/uso terapéutico , Sumatriptán/uso terapéutico , Adulto , Acatisia Inducida por Medicamentos/prevención & control , Analgésicos/administración & dosificación , Analgésicos/efectos adversos , Sedación Consciente , Difenhidramina/administración & dosificación , Difenhidramina/uso terapéutico , Método Doble Ciego , Quimioterapia Combinada , Servicio de Urgencia en Hospital , Femenino , Humanos , Infusiones Intravenosas , Infusiones Subcutáneas , Masculino , Náusea/inducido químicamente , Dimensión del Dolor/efectos de los fármacos , Proclorperazina/administración & dosificación , Proclorperazina/efectos adversos , Estudios Prospectivos , Prevención Secundaria , Sumatriptán/administración & dosificación , Sumatriptán/efectos adversosRESUMEN
Headache is a very common medical complaint. Four to six percent of the population will have a debilitating headache in their lifetime; and 1-2% of all Emergency Department (ED) visits involve patients with headaches. Although promethazine is used frequently, it has never been studied as a single-agent treatment in undifferentiated headache. We hypothesized that promethazine would be superior to prochlorperazine in the treatment of headache. We conducted a prospective, double-blinded, randomized, controlled trial on patients presenting to our ED between May and August 2005 with a chief complaint of headache. Each subject was randomized to receive either intravenous promethazine 25 mg or prochlorperazine 10 mg, and graded the intensity of their headache on serial 100-mm visual analog scales (VAS). Patients with dystonic reactions or akathesia were treated with diphenhydramine. Adequate pain relief was defined as an absolute decrease in VAS score of 25 mm. After discharge from the ED, patients were queried regarding the recurrence of headache symptoms, the need for additional pain medications, and the occurrence of any side effects since discharge. Thirty-five patients were enrolled in each group. Both drugs were shown to be effective in treatment of headaches. Prochlorperazine provided a faster rate of pain resolution and less drowsiness when compared to promethazine. Both medications were individually effective as abortive therapy for headache. Prochlorperazine was superior to promethazine in the rate of headache reduction and rate of home drowsiness, with similar rates of akathesia, nausea resolution, patient satisfaction, and headache recurrence within 5 days of discharge.
Asunto(s)
Antagonistas de Dopamina/uso terapéutico , Cefalea/tratamiento farmacológico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Proclorperazina/uso terapéutico , Prometazina/uso terapéutico , Adolescente , Adulto , Método Doble Ciego , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenAsunto(s)
Intoxicación/diagnóstico , Intoxicación/terapia , Psicotrópicos/efectos adversos , Adolescente , Anticonvulsivantes/uso terapéutico , Clorhidrato de Atomoxetina , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Niño , Muerte Súbita/etiología , Trastorno Depresivo/tratamiento farmacológico , Humanos , Propilaminas/efectos adversos , Propilaminas/envenenamiento , Psicotrópicos/envenenamiento , Intento de Suicidio , Ácido Valproico/uso terapéuticoRESUMEN
Poison centers save money and lives. Individual patients and their doctors benefit from local poison center availability, as do healthcare facilities and insurance companies. All have a stake in a stable poison control system. It is likely that the greatest contribution of poison control centers to society has yet to be realized. Poison control centers already possess an efficient, realtime surveillance mechanism (TESS). With increased funding, this can be expanded and made more available outside the poison control community. TESS can be used to detect chemical releases or attacks and environmental and infectious disease outbreaks as they occur - long before individual healthcare providers could connect the dots. In conclusion, while the value of a nationwide poison control system to society is well recognized, its future is not as clear. Establishing a stable system to monitor and treat poisonings in the US will take political will at the local, state, and federal levels to ensure full funding for years to come.