http://www.sudoc.fr/257028633 fr FR Thèse d’exercice Prise en charge et devenir des intoxications aux opioïdes au service d'accueil des urgences du CHU de Strasbourg : évolution sur 10 ans/thèse présentée pour le diplôme de docteur en médecine, diplôme d'État, mention médecine générale 2021-06-30 Analgésiques Intoxication Sala Timothé Opiacés Service hospitalier d'urgences Gestion des soins aux patients 610.6 application/pdf Accès libre https://publication-theses.unistra.fr/public/theses_exercice/MED/2021/2021_SALA_Timothe.pdf Médecine générale Introduction: Hospitalizations related to opioid use are increasing in France, placing emergency departments in the front line. The objective of our study was to evaluate the management of these intoxications in emergency departments, and its evolution over 10 years. The secondary objectives were to study the predictive factors of secondary deterioration and Naloxone precipitated withdrawal. Method: We conducted a single-center retrospective study over 10 years (2011 - 2020) in the emergency department of the University Hospital of Strasbourg. Patients admitted to the emergency department for opioid intoxication were eligible if their records allowed analysis of management and outcome. These parameters were collected in order to compare them between 2011 - 2015 and 2016 - 2020, and to compare patients with secondary deterioration, or induced withdrawal, to those without. Results: Naloxone reversal (47.1% of the population) resulted in a gain of 5.5 points in respiratory rate and 3.5 points in GCS. 33% of patients were admitted to the ICU. In the degradation group (47.4%), there was no difference between immediate intubation and reversal on the occurrence of aspiration pneumonia (p=0.05). Over 10 years there was no more secondary deterioration (p=0.76) but more admission in hospital ward (24 to 41%; p=0.03), reflecting an aging population. Bradypnea (OR 3.88), signs of inhalation (OR 2.75) and poor blood gas analysis results on admission were predictive of deterioration in univariate analysis. Naloxone reversal was predictive in multivariate analysis (OR 2.5). Induced withdrawal was rare (8.56% of reversions) and was not associated with the occurrence of inhalation pneumonia (p=0.27). Conclusion: The prognosis of opioid intoxication is severe. New patterns of intoxication seem to appear but are not associated with increased deterioration. Intubation and early transfer to intensive care should be considered by the emergency physician in the presence of clinical signs of severity on admission, signs of inhalation and blood gas analysis which are predictive factors of deterioration. Naloxone-induced withdrawal is an infrequent complication with current titration protocols Faculté de médecine, maïeutique et sciences de la santé Chabrier, Sylvie These d'exercice Unistra