Drugs of abuse: the highs and lows of altered mental states in the emergency department.

@article{Meehan2010DrugsOA,
  title={Drugs of abuse: the highs and lows of altered mental states in the emergency department.},
  author={Tim Meehan and Sean M. Bryant and Steven E. Aks},
  journal={Emergency medicine clinics of North America},
  year={2010},
  volume={28 3},
  pages={
          663-82
        }
}
The diagnosis and management of poisoned patients presenting with alterations in mental status can be challenging, as patients are often unable (or unwilling) to provide an adequate history. Several toxidromes exist. Recognition hinges upon vital signs and the physical examination. Understanding these "toxic syndromes" may guide early therapy and management, providing insight into the patient's underlying medical problem. Despite toxidrome recognition guiding antidotal therapy, the fundamental… Expand
Disorders of consciousness induced by intoxication.
TLDR
A comprehensive approach to patients with altered consciousness and suspected poisoning is discussed and does not intend to be a substitute for the need for consultation with a clinical toxicologist qualified in the diagnosis and treatment of poisoned patients. Expand
Preventing and Managing Risk of Violence and Suicide in Substance-Abusing Patients in the Emergency Department
TLDR
Clinicians must assess for the presence of any active medical or psychiatric problems that could contribute to risk while evaluating the extent of possible intoxication and/or withdrawal while treating substance-using patients in the ED. Expand
Substance Use in Adolescents Presenting to the Emergency Department
TLDR
The common ways drug and alcohol problems present in theED, clinical assessment of the patient and family, screening, laboratory testing, brief interventions in the ED, and referral to treatment beyond the ED are reviewed. Expand
Diagnosis and Treatment of Altered Mental Status
TLDR
In cases of brain death, it is essential to understand the diagnostic criteria as well as adjunctive studies. Expand
Altered Mental Status in Cirrhosis
TLDR
The overall mortality of patients admitted with AMS was greater than with NMS, particularly for those with infection or structural lesions, emphasizing the importance of a search for these causes of AMS in all patients with cirrhosis. Expand
ICD-10 mental and behavioural disorders due to use of crack and powder cocaine as treated at a public psychiatric emergency service: An analysis of visit predictors
TLDR
The findings point to a population at risk for frequent psychiatric emergency service visits: individuals over 25 years, which should be targeted for interventions on entry into public healthcare due to increased psychiatric morbidity and greater clinical morbidity already confirmed by previous studies. Expand
Clinical Aspects of Drug-Facilitated Sexual Assault
Many drugs, alone or in combination, have the potential to be used to facilitate sexual assault, including alcohol, benzodiazepines, antihistamines, antidepressants, marijuana, cocaine, andExpand
The general approach to the poisoned patient.
TLDR
Understanding the nuances of a toxicological history and physical examination can aid in the management of poisoned patients and consultation with a medical toxicologist or regional poison control center can positively impact diagnosis, management, and disposition. Expand
Guidance on the clinical management of acute and chronic harms of club drugs and novel psychoactive substances.
TLDR
National guidelines produced by the National Institute for Health and Care Excellence determine the wider principles within which treatment and care should be provided within drug services, EDs, primary care, sexual health and mental health services in the UK. Expand
Management of pharmaceutical and recreational drug poisoning
TLDR
A substantial consensus was reached for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N -acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively. Expand
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 67 REFERENCES
Rapid tranquilization of the violent patient.
TLDR
A brief overview of the pharmacokinetics of antipsychotic medication is provided and the following aspects of RT are reviewed: route of administration, dosing, time intervals between doses, side effects, and alternative medications for RT. Expand
The poisoned patient with altered consciousness. Controversies in the use of a 'coma cocktail'.
TLDR
The risks and benefits of standard diagnostic and therapeutic interventions are presented to guide clinicians through this critical period of decision making and analysis favors empirical administration of hypertonic dextrose and thiamine hydrochloride to patients with altered consciousness. Expand
Jimsonweed intoxication in adolescents and young adults.
TLDR
Seventy-three jimsonweed exposures reported to a regional poison center over a five-year period were reviewed, and almost 40% of the medically treated patients received physostigmine for severe hallucinations. Expand
Acute phencyclidine intoxication: incidence of clinical findings in 1,000 cases.
In 1,000 cases of phencyclidine (PCP) intoxication evaluated at the time of first examination in an emergency department, the incidence of "typical" findings was found to be lower than has beenExpand
Diphenhydramine-induced toxic psychosis.
TLDR
The clinical presentation of toxic psychosis, its differential diagnosis, and its subsequent treatment are discussed. Expand
Visine overdose: case report of an adult with hemodynamic compromise.
TLDR
A case of tetrahydrozoline ingestion in an adult who presented with chest pain, bradycardia, mental status depression, miosis, and other signs and symptoms of imidazole compound poisoning is presented. Expand
Adverse events after naloxone treatment of episodes of suspected acute opioid overdose
TLDR
Out-of-hospital naloxone treatment by paramedics seems to save several lives a year without a high risk of serious complications, although adverse events were common among patients treated for opioid overdose in an out- of-hospital setting, serious complications were rare. Expand
Acute overdosage with benzodiazepine derivatives
TLDR
Ingestion of benzodiazepines together with other drugs appears to be considerably more common than Benzodiazepine overdosage alone as a cause of intoxication, and the severity of intoxication in such cases of multiple drug ingestion probably depends largely on the type and quantity of nonbenzodiazep drugs taken. Expand
Adolescent salvia substance abuse.
TLDR
A 15-year-old man with a history of salvia and marijuana use presented to psychiatric emergency services with acute onset of mental status changes characterized by paranoia, déjà vu, blunted affect, thought blocking and slow speech of 3 days' duration. Expand
Complications of diagnostic physostigmine administration to emergency department patients.
TLDR
D diagnostic physostigmine administration was without significant complication when given to ED patients suspected of having antimuscarinic delirium, and contributes to the safety profile of physostIGmine. Expand
...
1
2
3
4
5
...