[ERTraumaJunkie]

Just curious. As popular as it is in this part of the country, I'm very thankful I've only seen one meth OD so far. I'm sure it won't be the last. Just wondering if we went about treating the right way: i.e, fluid bolus, external cooling, MASSIVE quantities of benzos. Any other suggestions? This was a first for everyone in the ER. Thanks!

[grammyr]

We always call Poison Control and follow their suggestions/protocols.

[traumaRUs]

It sounds like you handled it right. The only additional thing I can come up with is the generous use of restraints - we've sedated and paralyzed and intubated for meth ODs because of the violence.

[phiposurde]

Originally Posted by traumaRUs

It sounds like you handled it right. The only additional thing I can come up with is the generous use of restraints - we've sedated and paralyzed and intubated for meth ODs because of the violence.

**** I went to a talk once give by a toxicologist and He was saying that paralyzing can become mandatory if we can't control the temperature!!

[Noryn]

Originally Posted by ERTraumaJunkie

Just curious. As popular as it is in this part of the country, I'm very thankful I've only seen one meth OD so far. I'm sure it won't be the last. Just wondering if we went about treating the right way: i.e, fluid bolus, external cooling, MASSIVE quantities of benzos. Any other suggestions? This was a first for everyone in the ER. Thanks!

It sounds like you did the right thing. Generally you will see cns agitation along with cardiac excitement with methamphetamine. Just be careful when you say meth because it can be confused with methadone. There really isnt an antidote, just management of the symptoms.

With a drug overdose, one of the main concerns is that you are causing GABA stimulation so when you have seizures traditional treatments like Dilantin are not that effective, hence why you give the massive amount of benzos which help to inhibit the stimulation. Generally if someone is hyperthermic with an amphetamine overdose it is coming from muscle activity in the form of tremors or seizures. So control of seizures, agitation and tremors is of the upmost importance which can also lead to rhabdomyolysis. If Benzos are not effective (and yes you have to give more than 1 or 2 mg of Ativan) then look at phenobarb.

Benzos will also help with the tachycardia and hypertension but if they are not effective you may have to go other routes. As far as the fever goes, it really depends. Most of the time you dont want to paralyze someone who has taken a drug overdose as as paralyzed pt will not display s/s of seizure activity however the electrical activity will still be going on in the brain. RSI is typically ok but I would hesitate to use continued paralysis. Diprivan is great to use along with benzos. So treat the fever with benzos, passive cooling initially.

If the temperature is extremely high, not responding then definitely inducing paralysis is the most effective intervention. But the pt would need continuous EEG monitoring at the bedside so seizures could be detected. Also consider possibility of malignant hyperthermia or neuro malignant syndrome.

[Toquay]

It just blows me away why anyone would ever choose to do meth...

http://www.drugfree.org/Portal/DrugI...ces/index.html

Toq

[nursekatie22]

Originally Posted by Toquay

It just blows me away why anyone would ever choose to do meth...

http://www.drugfree.org/Portal/DrugI...ces/index.html

Toq

This may sound like a dumb question, but all of the "afters" but one seem to have these red lacerations/wounds on their faces. Why is that? I've never had to deal with any ODs before so I'm very curious.

[EricEnfermero]

Those are skin sores that are thought to result from face-picking. Meth can cause agitation and a sensation of "meth bugs" crawling on the face.

[Geena]

Originally Posted by EricEnfermero

Those are skin sores that are thought to result from face-picking. Meth can cause agitation and a sensation of "meth bugs" crawling on the face.

Sometimes you find the whole body is covered with red bumps - we see a lot of meth skin popping here, now this is so sad.

[sharann]

That is very disturbing. I will forward those before and afters to everyone I know. Maybe if even one person who was "curious" saw it..
Meth bugs, are they the same as what you call skin popping? I am obviously very undereducated in drug vocabulary.