Dirty Drugs
A 25-year-old man presents to the emergency department with palpitations. He reports injecting heroin, which he obtained from a new source, and is concerned that it was “not just heroin.” His initial vital signs include blood pressure 150/90 mm Hg, heart rate 130 bpm, respiratory rate 16 breaths per minute, and pulse oximetry 99% on room air. The patient appears uncomfortable, but is alert and oriented. His physical exam is remarkable for tachycardia and agitation.
The concern for an altered illicit drug is not uncommon in the ED. Cases and epidemics of tainted illicit drugs have been reported historically; the fi...
Source: The Tox Cave - December 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Dirty Drugs
A 25-year-old man presents to the emergency department with palpitations. He reports injecting heroin, which he obtained from a new source, and is concerned that it was “not just heroin.” His initial vital signs include blood pressure 150/90 mm Hg, heart rate 130 bpm, respiratory rate 16 breaths per minute, and pulse oximetry 99% on room air. The patient appears uncomfortable, but is alert and oriented. His physical exam is remarkable for tachycardia and agitation.
The concern for an altered illicit drug is not uncommon in the ED. Cases and epidemics of tainted illicit drugs have been reported historically; the firs...
Source: The Tox Cave - December 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
To Bind or Not to Bind?
An 88-year-old man with a history of congestive heart failure, hypertension, and diabetes mellitus presented to the ED from a nursing home with altered mental status. EMS reported that the patient has had a decreased appetite, diarrhea, and weakness for three days. His initial vital signs were temperature 97.9°F, heart rate 79 bpm, blood pressure 116/64 mm Hg, respiratory rate 16 bpm, and pulse oximetry 98% on room air. His physical exam was remarkable for a depressed level of consciousness. Lab findings showed a creatinine of 2.6 mg/dl, a BUN of 60 mg/dl, and normal potassium and magnesium. His ECG is shown below.
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Source: The Tox Cave - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
To Bind or Not to Bind?
An 88-year-old man with a history of congestive heart failure, hypertension, and diabetes mellitus presented to the ED from a nursing home with altered mental status. EMS reported that the patient has had a decreased appetite, diarrhea, and weakness for three days. His initial vital signs were temperature 97.9°F, heart rate 79 bpm, blood pressure 116/64 mm Hg, respiratory rate 16 bpm, and pulse oximetry 98% on room air. His physical exam was remarkable for a depressed level of consciousness. Lab findings showed a creatinine of 2.6 mg/dl, a BUN of 60 mg/dl, and normal potassium and magnesium. His ECG is shown below.
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Source: The Tox Cave - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Shadow Boxer
Conclusion
The patient was admitted to a monitored setting with a diagnosis of GHB withdrawal. He had multiple episodes of agitation and combativeness during his admission. He was administered escalating doses of diazepam, a total of 480 mg of diazepam IV during his eight-day hospital stay. The patient recovered in eight days, and was referred to drug rehabilitation.
References
1. Dyer JE, Roth B, Hyma BA. Gamma-hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37(2):147.
2. Tarabar AF, Nelson LS. The gamma-hydroxybutyrate withdrawal syndrome. Toxicol Rev 2004;23(1):45.
3. Craig K, Gomez HF, et al. Severe g...
Source: The Tox Cave - October 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Shadow Boxer
Conclusion
The patient was admitted to a monitored setting with a diagnosis of GHB withdrawal. He had multiple episodes of agitation and combativeness during his admission. He was administered escalating doses of diazepam, a total of 480 mg of diazepam IV during his eight-day hospital stay. The patient recovered in eight days, and was referred to drug rehabilitation.
References
1. Dyer JE, Roth B, Hyma BA. Gamma-hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37(2):147.
2. Tarabar AF, Nelson LS. The gamma-hydroxybutyrate withdrawal syndrome. Toxicol Rev 2004;23(1):45.
3. Craig K, Gomez HF, et al. Severe gamma-h...
Source: The Tox Cave - October 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Crack the Case
Conclusion
The patient received antibiotics, steroids, and nebulized albuterol during his hospital admission. His symptoms and chest x-ray findings improved within 24 hours. Blood cultures were negative, and antibiotics were discontinued. He was discharged home with instructions to discontinue use of crack cocaine and given a prescription for oral steroids and an albuterol inhaler.Tags: tachycardia, scattered rhonchi, wheezing, emergency medicine, crack, cocainePublished: 9/2/2014 11:24:00 AM (Source: The Tox Cave)
Source: The Tox Cave - September 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Crack the Case
Conclusion
The patient received antibiotics, steroids, and nebulized albuterol during his hospital admission. His symptoms and chest x-ray findings improved within 24 hours. Blood cultures were negative, and antibiotics were discontinued. He was discharged home with instructions to discontinue use of crack cocaine and given a prescription for oral steroids and an albuterol inhaler.Tags: tachycardia, scattered rhonchi, wheezing, emergency medicine, crack, cocainePublished: 9/2/2014 11:24:00 AM (Source: The Tox Cave)
Source: The Tox Cave - September 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
AdDRESSing the Causes of Rash
Conclusion: DRESS syndrome is a rare but potentially life-threatening condition with an estimated mortality rate of 10 percent. Suspicion must be high because it may present as a spectrum of nonspecific clinical and laboratory findings.Tags: rash, tox cave, DRESS, DRESS syndrome, RegiSCAR, hepatitis, myocarditis, myositisPublished: 8/7/2014 2:50:00 PM (Source: The Tox Cave)
Source: The Tox Cave - August 7, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
AdDRESSing the Causes of Rash
Conclusion: DRESS syndrome is a rare but potentially life-threatening condition with an estimated mortality rate of 10 percent. Suspicion must be high because it may present as a spectrum of nonspecific clinical and laboratory findings.Tags: rash, tox cave, DRESS, DRESS syndrome, RegiSCAR, hepatitis, myocarditis, myositisPublished: 8/7/2014 2:50:00 PM (Source: The Tox Cave)
Source: The Tox Cave - August 7, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Hot Topic
A 58-year-old man presented unresponsive following a seizure at home. His brother stated that he became progressively confused over the course of a few hours and then started shaking. EMS reports tonic-clonic seizures that resolved following administration of 5 mg of midazolam IM.
The patient was unresponsive and hyperthermic on arrival. He was intubated for airway protection, covered with ice packs, and administered normal saline intravenously. His rectal temperature is 41.9˚C (107.4˚F), blood pressure is 94/45 mm Hg, heart rate is 160 beats/minute, and the respiratory rate is 16 breaths/minute with an oxygen saturat...
Source: The Tox Cave - June 23, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Hot Topic
A 58-year-old man presented unresponsive following a seizure at home. His brother stated that he became progressively confused over the course of a few hours and then started shaking. EMS reports tonic-clonic seizures that resolved following administration of 5 mg of midazolam IM.
The patient was unresponsive and hyperthermic on arrival. He was intubated for airway protection, covered with ice packs, and administered normal saline intravenously. His rectal temperature is 41.9˚C (107.4˚F), blood pressure is 94/45 mm Hg, heart rate is 160 beats/minute, and the respiratory rate is 16 breaths/minute with an oxygen saturatio...
Source: The Tox Cave - June 23, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
