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Toxikologische Notfälle

Primary care from the emergency service in cases of poisoning

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Zusammenfassung

Etwa 10% der Notarzteinsätze betreffen Vergiftungen, überwiegend mit suizidalem Hintergrund, meist mit Schlafmitteln und/oder Psychopharmaka. Diese sind durch lebensrettende Basismaßnahmen, Sicherung der Atemwege und assistierte/kontrollierte Beatmung gut zu beherrschen. Wichtigstes Ziel ist die Vermeidung einer Aspiration. Psychopharmakavergiftungen bedürfen wegen ihrer Kardiotoxizität besonderer Beachtung. Für bestimmte Vergiftungen stehen Antidote zur Verfügung. Im Rettungsdienst sind 4-DMAP gegen Zyanidvergiftung, 1%iges Atropin sowie Obidoxim gegen Organophosphatvergiftung unverzichtbar. Besondere Bedeutung haben auch Vergiftungen mit Antiarrhythmika. Betroffene bedürfen bereits vor Ort einer maximalen Therapie. Es kommen zur Anwendung: bei Vergiftung mit Klasse-IA- und -IC-Antiarrhythmika wie auch bei TCA-Vergiftung Natriumbikarbonat, bei Klasse-II-Antiarrhythmika hohe Dosen an Adrenalin, bei Klasse-III-Antiarrhythmika Kalium und Dopamin, bei Klasse-IV-Antiarrhythmika Kalzium und Katecholamine.

Abstract

About 10% of all medical emergency call-outs concern intoxications, in most cases with the idea of suicide in the background and mostly with hypnotics or psychopharmaceuticals. These cases are usually well controlled by means of basic life support (BLS) and assisted or controlled ventilation. The most important aim is to avoid aspiration. Antidotes are available for poisoning by some substances. It is essential that the emergency service is equipped with 4-DMAP for cyanide intoxication and with 1% atropine and obidoxim for organophosphate poisoning. Particular importance also attaches to anti-arrhythmics. Those affected need maximum treatment at the scene. The agents to use are sodium bicarbonate in the case of class Ia and Ic anti-arrhythmics, as for tricyclic antidepressants; high doses of adrenaline when class II anti-arrhythmics have been taken; potassium and dopamine when class III anti-arrhythmics are involved; and calcium and catecholamines when class IV anti-arrhythmics have been taken.

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  1. Toxikologische Abteilung, II. Medizinische Klinik, Technische Universität München, Ismaninger Straße 22, 81675 , München, Deutschland

    T. Zilker

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Zilker, T. Toxikologische Notfälle. Notfall Rettungsmed 10, 443–459 (2007). https://doi.org/10.1007/s10049-007-0952-1

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