drdĒv
02-22-2007, 02:05 PM
A teenager comes to your ED with euphoria, paranoia, and hallucinations. Would you suspect psychotropic drugs, such as phencyclidine (PCP) ... or common cough medicine that you can buy in any drugstore?
According to a new report from the Substance Abuse and Mental Health Services Administration, an ingredient in cough medicines was a contributing factor in 12,584 ED visits during 2004, and 5,581 of thosevisits were attributed to nonmedical use. (For a copy of the report,go to . Click on "Emergency Department VisitsInvolving Dextromethorphan.")
When taken in large amounts, dextromethorphan (DXM) can produce hallucinations and a "high" similar to PCP. Side effects include blurred vision, loss of physical coordination, abdominal pain, and rapid heartbeat.
At Avera McKennan Hospital in Sioux Falls, SD, ED nurses have beenseeing more of these cases recently, reports Linda March, RN, clinical educator for the ED. "I have personally cared for a teenager with this type of ingestion. He had consumed an entire box of Coricidin tablets," she says. ED nurses monitored vital signs frequently, gave oxygen and intravenous fluid therapy, and the patient was admitted for continued care and monitoring, says March.
Ask the patient what type of preparation they consumed; what dose;the amount consumed; when taken; if they have vomited since consuming the medication; and if they have taken anything else with it, such as alcohol, antidepressants, or other drugs, says March.
There is a tendency to think that because a medication is available over the counter, it's safe, says March. "Parents don't realize thepotential danger of its use, and it lacks the stigma of cocaine or heroin." (For educational information about dextromethorphan to give parents or patients, go to . Click on "Get involved" and then "Legal but Lethal: The Danger of Abusing Over-the-Counter Drugs.")
The drug is particularly dangerous when used along with antidepressants or the club drug ecstasy, says March. "The other danger is thatmany of these cold preparations contain acetaminophen, and there is risk of permanent liver damage when taken in high doses," she says.
Whenever you have a patient whose behavior is bizarre, and you have no history of head injury or trauma, suspect an overdose or chemical abuse, says Teri Howick, RN, nurse educator for the ED at McKay DeeHospital in Ogden, UT. "Rule out high or low blood sugars, and ultimately brain tumors, but nine out of 10 times, it's going to be drugs," she says. "Once you've determined that, it's important to try and isolate the drug, but often you have a polypharmacy."
The rule of thumb is to give supportive care, such as using vasopressors if the patient develops low blood pressure, says Howick. "Treat and support the systems until whatever chemicals have been used wear off, and hope no permanent damage was done," she says.
Patients require diligent monitoring for respiratory depression and cardiovascular collapse, says March. "Sometimes Narcan, a narcotic antagonist, has been used with intermittent success to reverse the respiratory depression," she says. "But if the patient is severely depressed, they may require mechanical ventilation on the respirator."
http://www.jems.com/news/279163/
According to a new report from the Substance Abuse and Mental Health Services Administration, an ingredient in cough medicines was a contributing factor in 12,584 ED visits during 2004, and 5,581 of thosevisits were attributed to nonmedical use. (For a copy of the report,go to . Click on "Emergency Department VisitsInvolving Dextromethorphan.")
When taken in large amounts, dextromethorphan (DXM) can produce hallucinations and a "high" similar to PCP. Side effects include blurred vision, loss of physical coordination, abdominal pain, and rapid heartbeat.
At Avera McKennan Hospital in Sioux Falls, SD, ED nurses have beenseeing more of these cases recently, reports Linda March, RN, clinical educator for the ED. "I have personally cared for a teenager with this type of ingestion. He had consumed an entire box of Coricidin tablets," she says. ED nurses monitored vital signs frequently, gave oxygen and intravenous fluid therapy, and the patient was admitted for continued care and monitoring, says March.
Ask the patient what type of preparation they consumed; what dose;the amount consumed; when taken; if they have vomited since consuming the medication; and if they have taken anything else with it, such as alcohol, antidepressants, or other drugs, says March.
There is a tendency to think that because a medication is available over the counter, it's safe, says March. "Parents don't realize thepotential danger of its use, and it lacks the stigma of cocaine or heroin." (For educational information about dextromethorphan to give parents or patients, go to . Click on "Get involved" and then "Legal but Lethal: The Danger of Abusing Over-the-Counter Drugs.")
The drug is particularly dangerous when used along with antidepressants or the club drug ecstasy, says March. "The other danger is thatmany of these cold preparations contain acetaminophen, and there is risk of permanent liver damage when taken in high doses," she says.
Whenever you have a patient whose behavior is bizarre, and you have no history of head injury or trauma, suspect an overdose or chemical abuse, says Teri Howick, RN, nurse educator for the ED at McKay DeeHospital in Ogden, UT. "Rule out high or low blood sugars, and ultimately brain tumors, but nine out of 10 times, it's going to be drugs," she says. "Once you've determined that, it's important to try and isolate the drug, but often you have a polypharmacy."
The rule of thumb is to give supportive care, such as using vasopressors if the patient develops low blood pressure, says Howick. "Treat and support the systems until whatever chemicals have been used wear off, and hope no permanent damage was done," she says.
Patients require diligent monitoring for respiratory depression and cardiovascular collapse, says March. "Sometimes Narcan, a narcotic antagonist, has been used with intermittent success to reverse the respiratory depression," she says. "But if the patient is severely depressed, they may require mechanical ventilation on the respirator."
http://www.jems.com/news/279163/