THE CONSERVATIVE MANAGEMENT OF BARBITURATE INTOXICATION: EXPERIENCE WITH 95 UNCONSCIOUS PATIENTS

Abstract

During the 6 year period (1953-1959) 140 patients were admitted to St. Vincent''s Hospital with a diagnosis of barbiturate intoxication. The report deals with 95 patients who were unconscious as a result of barbiturate intoxication and presented a therapeutic problem. There was one mortality. Analysis of the data indicated that the most important items of treatment are (1) main- tenance of a clear airway, and (2) maintenance of blood pressure using vasopressor agents, and (3) meticulous nursing with special attention to vital signs, positioning of patients, and attention to eye and skin care. Only one patient in this group received a therapeutic dose of stimulatory drugs. Gastric lavage was performed on many. There was no indication that this did any good. On the other hand, 5 who were lavaged aspirated gastric contents. In 2 of these obstruction of the air way was severe enough to warrant tracheotomy. In 2 other patients, vasomotor collapse followed gastric intubation. Despite many prolonged comas, elective tracheotomy was only deemed necessary on one occasion. Antibiotics were given "prophylactically" to 61 patients. Pneumonia developed in 2 of these patients and fever in 12 others. There was one case of pneumonia among the group who did not receive antibiotics. The mortality rate in this series of patients is far superior to the mortality rates reported by other authors in which vigorous analeptic treatment was used.