Diagnostic indicators in the early recognition of severe cocaine intoxication.

Hassan, T B; Pickett, J A; Durham, Stuart; Barker, Paul

doi:10.1136/emj.13.4.261

Cited by 16 publications

(14 citation statements)

References 19 publications

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“…4,8 Life threatening complications include cardiac arrhythmias, myocardial infarction, cardiovascular collapse, seizures, rhabdomyolysis, metabolic acidosis, hyperpyrexia and intracranial haemorrhage. 5,9 A further problem for the examining doctor is that the typical body-stuffer has a personal history of drug misuse and identification of symptoms of cocaine intoxication due to leakage from an ingested package may be complicated by co-existent intoxication with other drugs. Thus, the forensic physician needs to be aware of the potential confounding effects of other drugs.…”

Section: Identificationmentioning

confidence: 99%

The fatal case of a cocaine body-stuffer and a literature review – towards evidence based management

Norfolk¹

2007

Journal of Forensic and Legal Medicine

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Section: Identificationmentioning

confidence: 99%

The fatal case of a cocaine body-stuffer and a literature review – towards evidence based management

Norfolk¹

2007

Journal of Forensic and Legal Medicine

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“…Severe metabolic acidosis has, however, been noted with stimulant drug use (notably cocaine), 5 and when exertion and stimulant drug use are combined.…”

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confidence: 99%

Metabolic Acidosis in Restraint‐associated Cardiac ArrestA Case Series

Hick

Smith

Lynch

1999

Academic Emergency Medicine

156

130

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Abstract. The mechanism of death in patients struggling against restraints remains a topic of debate. This article presents a series of five patients with restraint-associated cardiac arrest and profound metabolic acidosis. The lowest recorded pH was 6.25; this patient and three others died despite aggressive resuscitation. The survivor's pH was 6.46; this patient subsequently made a good recovery. Struggling against restraints may produce a lactic acidosis. Stimulant drugs such as cocaine may promote further metabolic acidosis and impair normal behavioral regulatory responses. Restrictive positioning of combative patients may impede appropriate respiratory compensation for this acidemia. Public safety personnel and emergency providers must be aware of the life threat to combative patients and be careful with restraint techniques. Further investigation of sedative agents and buffering therapy for this select patient group is suggested. Key words: metabolic acidosis; restraint -physical; heart arrest; cardiac arrest. AC-ADEMIC EMERGENCY MEDICINE 1999; 6:239 -243 M ANAGEMENT of violent and agitated patients is a significant problem for public safety and emergency medical agencies, and death occasionally occurs during restraint of these patients. The cause of death in these circumstances has not been elucidated. Speculation has focused on autonomic reflexes, restraint stress, 1 agitated delirium from stimulant drugs, 1 and positional asphyxia due to use of the hobble (or ''hog-tie'') position as potential contributing factors.2 -4 Acidosis has not been cited as a contributing factor in restraint-associated death. Severe metabolic acidosis has, however, been noted with stimulant drug use (notably cocaine), 5 and when exertion and stimulant drug use are combined.6 -8 Profound metabolic acidosis can have significant negative cardiovascular effects, including promotion of dysrhythmias and autonomic instability, which may contribute to cardiovascular collapse.We present five cases of cardiovascular collapse occurring in ED patients who were struggling despite maximal restraint techniques. They were all profoundly acidotic. Our experience with these cases led to institution of an aggressive proactive CASE 1A 36-year-old man was acting extremely agitated and belligerent on a downtown sidewalk. When approached, he attacked a police officer and ran. He was subsequently subdued by several officers. He was transported to the ED, where he continued to fight vigorously while lying prone with his hands cuffed behind him. Breath analysis was negative for ethanol. Shortly thereafter, the patient had a witnessed respiratory arrest. He was intubated within 4 minutes of his apnea. Shortly after intubation, a 15-second episode of asystole was noted; he recovered a sinus rhythm at a rate of 140 beats/ min after epinephrine, atropine, and hyperventilation. His initial arterial blood gas (ABG) obtained 5 minutes after intubation was pH 6.46, pCO 2 49 mm Hg, pO 2 523 mm Hg, and a bicarbonate (HCO 3 ) of 4 mEq/L. Aggressive fluid resus...

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“…Cocaine is a stimulant but has been reported as contributing to cases of cardiac arrhythmias and respiratory arrest. 10 Recommendations from the literature suggest evaluation of vital signs for 5 to 10 minutes after discontinuation of resuscitation and before certification of death. 1 6 This simple solution may avoid missing similar cases.…”

Section: Discussionmentioning

confidence: 99%