The Case:
Male in his 20's in the early morning hours unconscious. Upon arrival the patients father came home and found his son unconscious on the living room floor. House is not in disarray, no trauma is noted to the patient, and nothing around the patient. Father states he has no diagnosed medical history, no Rx meds, however years ago the patient struggled with cocaine abuse. Despite such his understanding is the patient has been cocaine free for the last 8 months. States it would be unlikely for him to consume excessive alcohol, no other Rx or recreational drug use, and the fathers Rx meds are all accounted for.
Initial vitals: GCS 3, flushed, sweaty HR 128 Reg, RR shallow 22, SPO2 88% ra, BGL 7.2, 82/54, T37.5C, Pupils sluggish at 4-5mm.
Prehospital 12-Lead ECG here:
If the 12-Lead is not showing properly you can click HERE to open it up in a browser window.
Sympathomimetic toxidrome Clinical features: delusions / paranoia / tachycardia / hypertension / hypotension (severe) / hyperthermia / sweating / piloerection / mydriasis / hyperreflexia / seizures
Useful Links (will open in separate browser windows):
Internet Book of Critical Care - Sodium Channel Blocker Toxicity https://emcrit.org/ibcc/nacb/
Internet Book of Critical Care - Sympathomimetic intoxication https://emcrit.org/ibcc/symp/
StatPearls - Cocaine Toxicity https://www.ncbi.nlm.nih.gov/books/NBK430976/
Medscape - Cocaine Toxicity (free registration required) https://emedicine.medscape.com/article/813959-overview
Life in the Fast Lane - Cocaine Toxicity https://litfl.com/cocaine-toxicity-ccc/
Popular Podcasts
NFL Daily with Gregg Rosenthal
Gregg Rosenthal and a rotating crew of elite NFL Media co-hosts, including Patrick Claybon, Colleen Wolfe, Steve Wyche, Nick Shook and Jourdan Rodrigue of The Athletic get you caught up daily on all the NFL news and analysis you need to be smarter and funnier than your friends.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com