Stimulant Poisoning/Overdose

Table of Contents

Aliases

Stimulant, cocaine, methamphetamine, amphetamines, PCP, phencyclidine, bath salts

Patient Care Goals

  1. Identify intoxicating agent
  2. Protect organs at risk for injury such as heart, brain, liver, kidney
  3. Determine if there is an antidote
  4. Treat the symptoms which may include severe tachycardia and hypertension, agitation, hallucinations, chest pain, seizure, and arrhythmia

Patient Presentation

Inclusion Criteria

  1. Tachycardia/tachydysrhythmias
  2. Hypertension
  3. Diaphoresis
  4. Delusions/paranoia
  5. Seizures
  6. Hyperthermia
  7. Mydriasis (dilated pupils)
  8. Stimulant/hallucinogenic (with stimulant properties) agents:
    1. Cocaine
    2. Amphetamine/methamphetamine
    3. Phencyclidine (PCP) (hallucinogen)
    4. Bupropion
    5. Synthetic stimulant drugs of abuse (some having mixed properties)
    6. Ecstasy
    7. Methamphetamine
    8. Synthetic cathinones (bath salts)
    9. Spice
    10. K2
    11. Synthetic THC
    12. Khat

Exclusion Criteria

No recommendations

Patient Management

Assessment

  1. Begin with the ABCDs:
    1. Airway is patent
    2. Breathing is oxygenating
    3. Circulation is perfusing
    4. Mental status
    5. Treat any compromise of these parameters
    6. Ask about chest pain and difficulty breathing
  2. Vital signs including temperature for hyperthermia
  3. Apply a cardiac monitor and examine rhythm strip for arrhythmias
  4. Check blood glucose level
  5. Monitor ETCO2 for respiratory decompensation
  6. Check a 12-lead EKG when possible
  7. Check for trauma, self-inflicted injury
  8. Law enforcement should have checked for weapons and drugs, but you may decide to repeat the inspection

Treatment and Interventions

  1. IV access for any fluids and meds
  2. Give fluids for poor perfusion; cool fluids for hyperthermia [see Shock and Hyperthermia/Heat Exposure guidelines]
  3. Treat chest pain as ACS and follow STEMI protocol if there is EKG is consistent with STEMI
  4. Consider treating shortness of breath as atypical ACS
    1. Administer oxygen as appropriate with a target of achieving 94-98% saturation
  5. Consider soft physical management devices especially if law enforcement has been involved in getting patient to cooperate [see Agitated or Violent Patient/Behavioral Emergency guideline]
  6. Consider medications to reduce agitation and other significant sympathomimetic findings for the safety of the patients and providers. This may improve behavior and compliance [see Agitated or Violent Patient/Behavioral Emergency guideline]
  7. Consider prophylactic use of anti-emetic
  8. If hyperthermia suspected, begin external cooling
  9. 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.

Notes – Stimulant Poisoning/Overdose