Case Study (05:39)
A 59-year-old is admitted on a Saturday night after being arrested. After admitting he suffered a myocardial infarction six years earlier, the man states he suffers from frequent nosebleeds, has lost his sense of smell, and feels spiders all over his body; his pupils are sluggish and dilated. The doctor's primary goals are to provide supportive care and prevent absorption even if he or she cannot determine the exact substance.
Initial Assessment (02:55)
Examine airway, breathing, circulation, disability, exposure, mental status, pupil size, pulse oximetry, vital signs, and blood and urine work. Ensure any substances found do not get on the healthcare provider.
Initial Treatment (03:09)
Put in an IV and perform a glucose finger-stick. The patient may not be willing to provide a patient history; ask the police, family, or friends. Consider calling the poison control center and explaining the patient's symptoms if unsure of the drug ingested.
Physical Assessment (06:18)
Examine the nervous system, pulse, and respiratory systems for altered states. Patients under the influence of methamphetamine, bath salts, phencyclidine, and alcohol withdrawal will present in excitation. Check the odor of the patient for clues to the drug ingested.
Tests Performed (03:54)
A "KUB" Radiograph can determine what kind of substance was ingested. Toxicology blood screens identify cocaine, morphine, benzo diazepam, opioids, amphetamines, PCP, marijuana, and ethanol. Some legal medications can cause false positives.
Bath Salts (01:55)
A Patient's heart rate will increase, appear euphoric or become violent. As withdrawal occurs the individual will become depressed and anxious. There are no FDA approved drugs available for treatment.
CNS Depressants and Cocaine (05:00)
This category of drugs can be taken orally, snorted, or given intravenously. Cocaine or crack is very addicting and causes high blood pressure, large pupils, and nosebleeds. Long term damage includes septum necrosis.
GHB and Marijuana (04:08)
Gamma-hydroxybutyrate is also known as G, Georgia home, greatest body, liquid ecstasy, liquid x, soap, or scoop. The drug decreases one's memory of events that occur while sleeping and can be used as a date rape drug because it is odorless and colorless. Tetrahydrocannabinol increases sensory perception but makes an individual drowsy.
Methamphetamines and Heroin (07:43)
Crystal meth looks like pieces of glass. Pregnant women may experience premature delivery, low birth weights, and the placenta separating from the uterus. There is no therapeutic use of heroin.
Fentanyl is not used as prescribed but crushed and snorted. Other types include Vicodin, Hydrocodone, Dilaudid, Methadone, and Oxycodone. Right now, there is an epidemic in America.
Prescription Stimulants and MDMA (03:59)
Other names include bennies, black beauties, crosses, hearts, LA turnaround, speed, and uppers. Athletes use the drug to make them faster and more alert. Ecstasy or Molly has no commercial purpose and is only made illegally.
PCP has no commercial purpose and is only made illegal. It is a dissociative drug and may lead to hallucinations. Rohypnol is another date rape drug that causes individuals to forget.
Synthetic Cannabinoids (02:29)
This drug is sometimes sold as incense in stores and can be smoked, swallowed, and ingested orally. Usually the drug is 100 times more potent than marijuana. It cannot be detected in blood tests.
Lab Studies (07:12)
Obtain a complete blood count, electrolyte, glucose, and blood gas panels. Always treat the patient's primary issue. Enhance elimination techniques; when appropriate antidotes should be administered.
Some patients may be able to leave quickly. Consider advocating a social worker and toxicology support. An individual should be placed in the ICU if an emergency intubation is required or seizures, a low systolic blood pressure, or a non-sinus cardiac rhythm occur,
Returning to the Case Study (07:55)
Focus on the airway, breathing, and circulatory system. Cool the patient, perform toxicology tests, and provide IV fluid. Call the poison control center and stabilize the patient.
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