title: Bath salts in the emergency department: a survey of emergency clinicians' experience with bath salts-intoxicated patients.
abstract: OBJECTIVE
  Several novel synthetic amphetamines have been marketed worldwide as "bath salts." The use of bath salts is associated with severe medical consequences resulting in a US federal ban over the last 3 years on the more common substances found in this group. Bath salts intoxication has a relatively nonspecific presentation, and urine toxicology confirmation in emergency departments (EDs) is impractical because the turnaround time is several days. Emergency clinicians must therefore rely heavily on patients' self-reports to verify the diagnosis. We performed an online survey of emergency clinicians to determine their degree of exposure to bath salts-intoxicated patients, the clinically relevant features of such patients, and the typical emergency management.
  
  
  METHODS
  We invited 124 physicians and physician assistants in 7 Cleveland Clinic EDs to participate in an online survey.
  
  
  RESULTS
  From a total of 43 of the 124 respondents, 77% did not specifically ask patients about bath salts use. Sixty percent had encountered a bath salts-intoxicated individual. Most respondents reported that the majority of patients were male, were between 19 and 29 years old, and used other drugs in addition to bath salts. Agitation, aggression/violence, and hallucinations were reported to be the most common presentations, and intravenous/intramuscular tranquilization was reported as the most often used management. Most patients were discharged home from the ED.
  
  
  CONCLUSIONS
  Despite the lack of toxicology screening in EDs, about two thirds of the surveyed emergency clinicians encountered bath salts-intoxicated individuals. Our study demonstrates the need for increased screening of bath salts intoxication in EDs, especially in agitated patients.
authors.affiliation: From the Department of Psychiatry and Psychology (MV, JMJ, RMD), the Cle-veland Clinic Foundation, Cleveland, OH; Cleveland Clinic Lerner College of Medicine (JMJ, RMD), Cleveland, OH; Alcohol and Drug Recovery Center (JMJ), the Cleveland Clinic Foundation, Cleveland, OH; and Case Western Reserve University School of Medicine (JJ), Cleveland, OH.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Vazirian
authors.forename: Jason M
authors.initials: JM
authors.lastname: Jerry
authors.forename: Jeffrey
authors.initials: J
authors.lastname: James
authors.forename: Roman M
authors.initials: RM
authors.lastname: Dale
mesh_terms: D000367:Age Factors; D000374:Aggression / Q000187:drug effects; D019969:Amphetamine-Related Disorders / Q000188:drug therapy / Q000453:epidemiology*; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006212:Hallucinations / Q000453:epidemiology; D006801:Humans; D009820:Ohio / Q000453:epidemiology; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014149:Tranquilizing Agents / Q000627:therapeutic use; D014754:Violence / Q000706:statistics & numerical data
chemical_list: D014149:Tranquilizing Agents