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Legalized Recreational Marijuana - What Will You See in the ED?

Emergency Article   (2,702 Views | 19 Replies | 733 Words)

traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

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Pot problems in the ED?

As more and more states are legalizing recreational marijuana, emergency departments will be seeing more and different issues. You are reading page 2 of Legalized Recreational Marijuana - What Will You See in the ED?. If you want to start from the beginning Go to First Page.

MunoRN has 10 years experience as a RN and specializes in Critical Care.

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7 hours ago, SolosGirl said:

It's been studied and documented to a ridiculous degree that cannabanoids not only decrease gastric secretions, but they also inhibit peristalsis:

"Cannabinoids inhibit electrically evoked contractions of isolated small intestine

The ability of cannabinoids to inhibit electrically evoked contractions of isolated preparations of small intestine mounted in organ baths and the underlying mechanisms have been the subject of many investigations over the past 30 years. These have involved experiments, mainly with guinea pig tissue, in which contractions have been produced by electrical stimulation of prejunctional neurones rather than by direct stimulation of intestinal smooth muscle."

https://gut.bmj.com/content/48/6/859

Just one example of one study.

Let's follow this critical line of thinking then, to it's conclusion. Basic nursing principles teach the novice nurse that "checking for bowel sounds", particularly after surgery or in the possibility of obstruction---is essential. If the bowel is obstructed in any way or peristalsis is suspended because of anesthesia or other medications---it then becomes difficult or impossible for food to traverse the intenstines.

What then, is the outcome of sluggish or paralyzed (densensitized receptors due to consistent and constant cannabanoid intake) bowel?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972088/

This dysfunction causes many things---especially malnutrition, obstruction of the bowel, possible perforation of the bowel---

Many of which----lead to the death of the patient.

Does the death of the patient include the bowel as well?

There are a number of processes that can cause varying degrees of reduced peristalsis, eating cheese or bread for instance, your assumption that because marijuana can cause a relatively mild reduction in peristalsis that it can then cause death is a bit silly. 

The mechanism by which marijuana slows peristalsis is self-limiting, and unlike other processes that can slow peristalsis marijuana has never been associated with bowel obstruction, perforation, or bowel ischemia, which is why it's sometimes used for therapeutic slowing of peristalsis for conditions such as IBS.  The number of deaths related to marijuana-associated decreased motility is zero.  

I get that there's a long-established stigma related to marijuana use and marijuana aficionados have a habit of overstating it's benefits, but don't think deceptively vilifying it or hostility towards those who use it is productive either. 

 

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subee has 45 years experience as a MSN, CRNA.

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Can anyone explain to me what happens to the qualitative measurements of MJ when it changes from a medicinal category to recreational?  Is "medical quality" MJ still available or does it become a free for all once it's sold as recreational?  Just wondering.  I got burned with some medical MJ from Colorado which made me highly suspicious of qualitative measurements of this product which claimed to be low in THC's and high in CBD's...not.

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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19 minutes ago, subee said:

Can anyone explain to me what happens to the qualitative measurements of MJ when it changes from a medicinal category to recreational?  Is "medical quality" MJ still available or does it become a free for all once it's sold as recreational?  Just wondering.  I got burned with some medical MJ from Colorado which made me highly suspicious of qualitative measurements of this product which claimed to be low in THC's and high in CBD's...not.

Legalization of 'medical marijuana' typically hasn't included strict requirements for laboratory analysis testing.  I don't know about the more recent states, but at least with the first two states to legalize recreational marijuana, Washington and Colorado, the legalization legislation included strict requirements for testing by a third party lab, so the percentages of cannabinoids should be fairly reliable.  In Colorado for instance, there weren't really any requirements for reliable laboratory testing prior to it becoming legalized for recreational use.

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Walti is a LPN, LVN, RN, EMT-I and specializes in ICU/ER mostley ER 25 years.

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Wow, far out man, this was really good, like it blew my mind away. Hey does anyone want pizza?

What can I say I was young in the 60s and 70s. I don't know that I've ever seen a case of hyperemesis D/T cannabis use. ON the other hand it might just be because we didn't check for that as a cause. I kind of think that most personal use of cannabis has fewer medical complications than other abusable substances. I do have concerns about the implications involving other medical issues. Of particular concern is patient education, I doubt that most patients will recall discharge instructions and allowing them to drive home after treatment is also a concern.

I do get so tired of the argument about if it wasn't safe they wouldn't have legalized it. I truly believe that it is dumbing down society.

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subee has 45 years experience as a MSN, CRNA.

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In the 70's, I went to MD Anderson in Houston to take a class in chemotherapy nursing (all very new at the time).  I did a rotation in the out-patient clinic where many patients were staying in near-by motel rooms for their treatments and secretarial crew members were calling constantly for taxis.  The patients were smoking weed freely around the clinic and by the time their cabs arrived they would be wandering around admiring the trees:).  It was like herding cats.

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myoglobin has 12 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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What will we see in the ED with legalized cannabis?

a. Perhaps less DUI's and trauma related accidents if fewer people drink and drive and instead stay home and utilize cannabis.

b.  Perhaps less injuries from shootings, fights, and stabbings given that the drug is associated with less aggression (in most people) than most other drug alternatives.

There are many bad things about chronic cannabis use including psychosis in those with specific gene mutations, and documented negative impacts on intelligence (to say nothing of lung damage if it is smoked rather than eaten).  However, it is far less deadly than alcohol and not even in the same ballpark with nicotine.  

Edited by myoglobin

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I have seen in a teen would was extremely thin and developed all the clinical signs in C.H.S as example needing to take hot showers, tiger balm, smokes a bowl a/day, retching, and losing weight with no relief inpatient. CT scan showed  the secondary diagnosis of Superior Mesenteric Artery Syndrome. Basically compression from loss of fat stores. Pt was transferred to get stented in larger facility.

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34 Posts; 2,432 Profile Views

Don't forget the crushing chest pain from over-eating edibles!!

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