Drugs of abuse: the highs and lows of altered mental states in the emergency department.
The diagnosis and management of poisoned patients presenting with alterations in mental status can be challenging, as patients are often unable (or unwilling) to provide an adequate history. Several toxidromes exist. Recognition hinges upon vital signs and the physical examination. Understanding these "toxic syndromes" may guide early therapy and management, providing insight into the patient's underlying medical problem. Despite toxidrome recognition guiding antidotal therapy, the fundamental aspect of managing these patients involves meticulous supportive care. The authors begin with a discussion of various toxidromes and then delve into the drugs responsible for each syndrome. They conclude with a discussion on drug-facilitated sexual assault ("date rape"), which is both an underrecognized problem in the emergency department (ED) and representative of the drug-related problems faced in a modern ED.
Meehan
Timothy J
TJ
Toxikon Consortium, Chicago, IL, USA. tmeeha3@gmail.com
Bryant
Sean M
SM
Aks
Steven E
SE
D019969:Amphetamine-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D018680:Cholinergic Antagonists / Q000009:adverse effects; D019970:Cocaine-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D003244:Consciousness Disorders / Q000139:chemically induced* / Q000175:diagnosis; D015198:Designer Drugs / Q000009:adverse effects; D004636:Emergency Service, Hospital; D006213:Hallucinogens / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008238:Lysergic Acid Diethylamide / Q000009:adverse effects; D008635:Mescaline / Q000009:adverse effects; D009293:Opioid-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D012640:Seizures / Q000139:chemically induced; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D014970:Xanthines / Q000009:adverse effects
D018680:Cholinergic Antagonists; D015198:Designer Drugs; D006213:Hallucinogens; D006993:Hypnotics and Sedatives; D014970:Xanthines; C008514:methylxanthine; D008238:Lysergic Acid Diethylamide; D008635:Mescaline