Intubation for patients with overdose: Time to move on from the Glasgow Coma Scale

Patients frequently present to the ED with drug overdose and reduced conscious level leading to coma. There is considerable practice variation around which patients require intubation. Indications include: (i) respiratory failure (including airway obstruction); (ii) to facilitate specific therapies...

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Bibliographic Details
Published in:Emergency medicine Australasia 2023-08, Vol.35 (4), p.702-705
Main Authors: Pellatt, Richard AF, Isoardi, Katherine, Keijzers, Gerben
Format: Article
Language:English
Subjects:
Coma - therapy
Drug Overdose - therapy
Glasgow Coma Scale
Humans
intubation
Intubation, Intratracheal
overdose
Risk Assessment
toxicology
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Summary:Patients frequently present to the ED with drug overdose and reduced conscious level leading to coma. There is considerable practice variation around which patients require intubation. Indications include: (i) respiratory failure (including airway obstruction); (ii) to facilitate specific therapies or intubation as a therapy in itself; and (iii) for airway protection in the unprotected airway. We argue that intubating a patient purely for (iii) is outdated and that most patients can be safely observed. There is a paucity of good quality research in the area of drug overdose with reduced consciousness. Teaching may be outdated and based on the use of the Glasgow Coma Scale in head trauma. Current low quality research suggests observation is safe. We recommend that patients undergo an individualised risk assessment of the need for intubation. We propose a flow diagram to aid clinicians in safely observing comatose overdose patients. This can be applied if the drug is unknown, or there are multiple drugs involved.
ISSN:1742-6731
1742-6723
DOI:10.1111/1742-6723.14254