Street Drugs
Jennifer Riley
Introduction
Use of street drugs may not be reported, may be denied, or underestimated
Reported drugs may have been adulterated, substituted, or combined with other drugs
Initial Management
Assess airway, breathing, and circulation
Assess vital signs
Supportive treatment and resuscitation as necessary
Consider DONT antidotes: Dextrose, Oxygen, Naloxone, Thiamine
Consider decontamination if indicated: activated charcoal, whole bowel irrigation
Consider other diagnoses
Look for toxidromes
Sympathomimetic Ingestion
Toxidrome: tachycardia, hypertension, hyperthermia, mydriasis, diaphoresis, increased bowel sounds
Common street drugs: ecstasy, cocaine, ketamine, amphetamine, methamphetamine
Ecstasy
Hyponatremia: SIADH, marathon dancing, sweating, water ingestion
Jaw clenching, bruxism
Cocaine
Arrhythmias: blocks sodium channels (wide QRS), QT prolongation
Myocardial ischemia/infarction: coronary artery vasospasm and/or thrombosis
Pneumothorax, pneumomediastinum, aortic dissection
Ketamine
Dissociation with hallucinations, vivid dreams
Complications
Hyperthermia, seizure, arrhythmia, rhabdomyolysis, acute renal failure, end organ damage, ARDS, DIC, intracranial hemorrhage, circulatory collapse
Investigations
Electrolytes (hyponatremia), CPK, and urine (rhabdomyolysis)
ECG: ischemia, arrhythmia, QRS, QT intervals
Drug screen
Others as indicated: CXR, CT head, etc.
Anticholinergic Ingestion
Anticholinergic toxidrome: flushed, dry skin, mydriasis, hyperthermia, hallucinations, tachycardia, hyper- or hypotension, decreased bowel sounds
Common street drugs: jimsonweed, abuse of over-the-counter medication (Benadryl® and Gravol®)
Complications: similar to sympathomimetic ingestion
Management
Similar to sympathomimetic ingestion
QRS widening and hypotension from sodium channel blockade, consider sodium bicarbonateRelated posts:
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