Stimulant Overdose 

Symptoms

  • Tachycardia/tachydysrhythmias
  • Hypertension
  • Diaphoresis
  • Delusions/paranoia
  • Seizures
  • Hyperthermia
  • Mydriasis (dilated pupils)

Clinical Management Options

EMT-B
• Place in position of comfort
• Oxygen target SpO2 92% – 96%  
• Obtain blood glucose level
• Consider external cooling if hyperthermic
Paramedic
• Consider IV/IO as appropriate
• Monitor ETCO2
• Obtain EKG when possible
• Consider fluid bolus
• Consider sedation if severely agitated
Consult Online Medical Control as Needed

Pearls

  • Stimulants can cause significant hyperthermia and lactic acidosis. It is important to reduce the metabolic activity in patients with severe hyperthermia and lactic acidosis as this can cause death. 
    • Consider sedation early in severely agitated patients to help reduce metabolic activity
  • Cocaine has sodium channel blocking effects and can cause significant cardiac conduction abnormalities with a widened QRS. Treatment is with sodium bicarbonate similar to a tricyclic antidepressant.
  • Patients with cocaine use and meth use are at higher risk for cardiac disease. Treat chest pain with high degree of suspicion.