1 / 135

Timothy B. Erickson, MD Professor: Department of Emergency Medicine University of Illinois @ Chicago

Street Drugs of Abuse Timothy B. Erickson, MD Professor: Department of Emergency Medicine University of Illinois @ Chicago Case #1 History A 25 yr old male is found unresponsive by friends at an inner city night club called the “Passion Pit”. He is brought to your ER by paramedics.

JasminFlorian
Télécharger la présentation

Timothy B. Erickson, MD Professor: Department of Emergency Medicine University of Illinois @ Chicago

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Street Drugs of Abuse Timothy B. Erickson, MD Professor: Department of Emergency Medicine University of Illinois @ Chicago

  2. Case #1 History • A 25 yr old male is found unresponsive by friends at an inner city night club called the “Passion Pit”. He is brought to your ER by paramedics.

  3. Physical Exam • Gen: Disheveled appearance, shallow breathing, responds to painful stimuli • Vitals: P=56 RR=6 BP=110/70 T=95 • Head: NC/AT • Eyes: Pinpoint pupils • Neck: Nontender no deformity • Lungs: Poor inspiratory effort, CTA

  4. Physical Exam • CV: Bradycardic RRR S1S2 no m’s • Abd: Soft with hypoactive BS • Rectal: Normal tone (-)Heme • G/U: Half-melted ice cubes placed on groin by friends at nightclub • Neuro: Moves all 4 ext, nonfocal • Skin: Cool, Arms with needle tracks

  5. Case Discussion • What are your priorities when managing this patient?

  6. Management Priorities • Airway • Breathing • Circulation • Assess for signs of trauma • Antidote administration

  7. Case Summary • Comatose patient • Pinpoint (miotic) pupils • Depressed respiratory drive • Bradycardia • Hypothermia

  8. Opioid Overdose • Heroin • Methadone • Codeine • Morphine • Fentanyl • Demeral • Propoxyphene

  9. HEROIN

  10. HEROIN

  11. HEROIN

  12. ANTIDOTE

  13. NALOXONE • Indicated in comatose patients with suspected drug overdose • Restrain patient prior to administration • Dose: 2-10mg IVP • Short half life (T1/2) • Naloxone drip may be required

  14. Clinical Course • After administration of 2mg of naloxone, the patient becomes more alert and begins to verbalize with spontaneous respiratory activity. • His vital signs are stable with NSR noted on the cardiac monitor.

  15. Clinical Course • Laboratory data including ECG and CXR are unremarkable. • The toxicology screen is positive for opiates.

  16. Clinical Course • The patient denies suicidal ideations and admits to frequent chronic IV heroin abuse claiming “I just had a bad cut tonight.” • He becomes more uncooperative and demands to be discharged….

  17. Case#2 History • The patient is a 28 yr old male who presents in police custody complaining of chest pain. He has no prior history of cardiac disease. • The patient was arrested at the local international airport for combative behavior while standing in line near the security area.

  18. Case Physical Exam • Gen: Patient is very agitated, clutching his chest • Vitals: P= 140 BP= 220/130 RR= 28 T=103.2 F • Eyes: Pupils equal: 7mm • Lungs: CTA • Ht: RRR S1S2 2/6 systolic murmur

  19. PHYSICAL EXAM • Abd: Distended with diffuse tenderness, hyperactive BS • Ext: Good pulse, no cyanosis, no needle tracks • Neuro: No focal defs • Skin: Diaphoretic

  20. “I’m having chest pain”

  21. Clinical Course • The patient now admits to swallowing several “condoms full of cocaine” before boarding the plane from Columbia to the U.S.

  22. Drug Smugglers • Describe the difference between a “Body Packer” and a “Body Stuffer”

  23. Packers and Stuffers • Body Packers: Drug smugglers who ingest large amounts of pure illegal contraband methodically wrapped in order to deliver “the goods” across international borders. • Body Stuffers: Individuals who “swallow the evidence” during drug raids (poorly wrapped but less pure).

  24. Body Stuffer

  25. Body Packer

  26. Cocaine • Cocaine hydrochloride= usual street preparation • Freebase cocaine(cocaine alkaloid)= cocaine is extracted with alkaline (buffered ammonia) and solvent is added(acetone). Freebase pops or cracks when heated hence the term “crack” • Rock of crack= cocaine hydrochloride heated with baking soda until a rock is formed-these are smoked in paraphernalia • Speedball-heroin laced with cocaine-no narcan

  27. Cocaine Toxicity (Sympathomimetic) • Hypertension • Tachycarida • Hyperthermia • Diaphoresis • Anxiety • Seizures • CVA/Intracranial bleed • Myocardial infarction

  28. Gastric Decontamination • Activated charcaol • Polyethlene glycol solution (aka: Go-lytely) • Surgical removal

  29. Cocaine & Chest Pain • Oxygen • Benzodiazepines • Nitroglycerin • B-Blockers- contraindicated • Hypertension control • Thrombolytic Agents (TPA) • Cath Lab / Angioplasty

  30. Clinical Course • The patient’s chest pain and hypertension resolves with large doses of NTG and benzodiazepines • The patient is administered activated charcoal and PEG solution by the ER physician.

  31. Clinical Course • Because of the ST segment elevations on ECG, the cardiologist elects to give TPA. • Since thrombolytics were given, the general surgeon refuses to take the patient to the OR for an exploratory lap and removal of the cocaine packets.

  32. Clinical Course • The patient subsequently develops seizure activity, worsening hyperthermia, rhabdomyolysis, and intracranial hemorrhage. • He expires 48 hrs after admission

  33. Case #3 History 17 y/o CF presents to the community hospital emergency department at 2:00AM with “fever and strange behavior” as per her parents. While waiting to be examined, the patient has a witnessed tonic-clonic seizure lasting 1 minute in duration.

  34. No PMH; No medications ; NKDA • Vitals: T=104.2F P=120 BP=100/90 RR=28 • PE: Gen: restless, agitated, confused HEENT: pupils 6mm & reactive, MMM CV: RRR, no MRG Lungs: CTA Abd: Soft, (+)BS, mild tenderness Skin: warm, dry, no rashes Neuro: No focal defs

  35. DIAGNOSTIC STUDIES • CBC: WNL • Lytes: 120/3.9/87/21 • Serum Osm=234, Urine Osm=261 • Urine Na: 82 • U/A: large blood (-)RBCs • CPK: 3,300 • CT head: normal

  36. Earlier that night: •Urine Tox Screen: + Amphetamines + Cannabis - EtOH, ASA, APAP

  37. AMPHETAMINES

  38. Ecstasy: The drug of a new generation.

  39. Ecstasy = MDMA • 3,4 methylenedioxymethamphetamine • X, E, M, XTC, Rolls, Adam, Bean, Hug Drug

  40. MDMA Properties and Mechanism of Action • Designer drug from the essential oil of the sassafras tree • Ring substituted amphetamine • Pharmacological effects are a blend of amphetamines and mescaline • Structure resembles natural neurotransmitters of Epi, DA • Biological actions and effects resemble those of Epi, DA, and serotonin

  41. Pharmacodynamics • Increases the net release of monoamine neurotransmitters (5-HT, NE, DA) from their axon terminals • MDMA binds to and blocks the serotonin reuptake transporter – flooding the terminals with 5-HT • Similar, weaker action on DA reuptake • Amphetamine like increase in NE • Increase in 5-HT and DA = mental effects • Increased NE=physical amphetamine effects

  42. MDMA analogues • MDA (3,4-methylenedioxyamphetamine) – “Love Drug” - similar in effect, more stimulating, twice as neurotoxic • MDE (N-ethyl-methylenedioxyamphetamine) “Eve” – more introspective experience • MMDA (3-methoxy-4,5-methylenedioxyamphetamine) – closed eye hallucinations, “brain movies” • MBDB (N-methyl-1-(1,3-benzodioxol-5-yl)-2-butanamine) – effects similar to MDA

  43. MDMA History • 1912 – first synthesized by Merck • 1914 – patented by Merck – manufactured as an appetite suppressant, never marketed • 1950’s- studied by US Army as potential agent in psychological warfare • 1970 – used in psychotherapy, “penicillin for the soul” • 1977 – class A illegal drug in UK • 1985 – Schedule I illegaldrug in U.S.

  44. Trends in Ecstasy Use • DEA seizures of Ecstasy Tablets: • 1996 – 13,342 tablets • 2000 – 949,257 tablets • 2001 - >4,000,000 tablets in 8 months

  45. Ecstasy Use by Students, 2000 (NIDA Studies) Perceived availability by 12th graders 51.4% (40.1%)

  46. MDMA Production and Sales • Street value = $25 per pill • Wholesale price = $2-$8 per pill • Production cost = 2-5 cents per pill • Majority of production and distribution linked to well organized crime networks in Europe (Amsterdam, Germany, UK) and Israel • Smaller labs all over US and Europe

  47. Areas of Usage • Highest at raves, dance clubs (as high as 91% of clubbers in dance scene in Scotland) • Dramatic increase in college use, suburban teens, house parties Millroy, CM, JRSM February 1999

  48. Physical CLUES • Glowsticks or lights • Lollipops • Pacifiers • Vick’s Vapor Rub and Nasal Inhaler • Fuzzy Mittens

  49. Most Predictive Factor of Drug Use = CLUB MUSIC!

  50. Methods of Administration • Mainly PO – stamped tablets, capsules • Intra-nasal – rapid absorption of crushed tablets or opened capsules • Intra-rectal – faster absorption than PO • Recreational usage varies from ½ pill to as much 15 pills in a 6 hour span

More Related