J.K. 25y.o. M

J.K. 25y.o. M

Presents to ED: pale, BP 70/40 (hypotensive),T 34C (hypothermic), HR 110 (tachycardic); painful, swollen, right leg..
1. Electrolyte imbalance dt drug use. Pt will be given IV electrolytes, isotonic solution, and/or PO calcium supplements to repair imbalance. Once calcium is repaired the other electrolytes will autorepair. The patient will need information about drug rehab and nutrition programs.
2. Right leg pain-possible DVT.DX & TX: ultrasound of right leg, IV heparin until INR is within normal; f/u with PCP and Coumadin. Daily INR draw. PT educated about foods, herbal remedies, drugs to avoid. Should be hospitalized until stable because of drug history. Moved to detox unit with medical treatment.
10 yr hx of heroin, cocaine,& amphetamine use.
1. Amphetamine withdrawal sx: Oversleeping • Excessive hunger that doesn’t go away •Pain and discomfort in the stomach as a result of overeating •Lack of coordination •Shaking and the potential for seizures •Dehydration •Tachycardia •Arrhythmia •Cardiac arrest
  1. Amphetamine OD: Irregular heartbeat, diarrhea, aggressiveness, panic, hallucinations, restlessness, tremor, rapid breathing, confusion, panic, nausea, vomiting, seizures, hyperthermia
    1. Amphetamine Treatments: If sx are not severe monitor vitals every two hour; encourage fluids; IV access "just in case"; IM benzodiazepine like Ativan or phenobarbital to prevent seizures and sedate. Seizures prevention is important because of the risk for intracranial hemorrhage (if suspected CT of head). IV crystalloid if probable kidney concerns; monitor fluid intake and output. Nitro for chest pain, get baseline EKG if possible. Clonidine for hypertension.
2. Heroin withdrawal symptoms: • Nausea • Vomiting •Diarrhea •Chills •Runny Nose •Goose Bumps •Sweating •Tears • Insomnia •Muscle • Joint pain •Restlessness •Yawning, •Abdominal cramps •Dilated pupils •Anxiety •Depression •Restless leg •Muscle spasms
  1. Heroin OD:slow heart rate and breathing, dry mouth, pinpoint pupils, muscle spasms, stopped breathing, cold and clammy skin, blue lips and fingernails, stomach spasms, weak pulse, constipation, low blood pressure, drowsiness, disorientation, extreme drowsiness, confusion, delirium, hallucination, seizures, coma and possibly death
    1. Opioid Treatments: check vital signs every two hours; complete a Clinical Institute Narcotic Assessment (CINA) every two hours; breathing support if needed (nasal cannula, ambu bag, tube);IV or IM narcotic antagonist (narcan); IV fluids (normal saline, half normal saline); provide PRN withdrawal meds (ativan,valium, bentyl, imodium, clonidine, acetaminophen and/or ibuprofen).
3. Cocaine withdrawal symptoms: •Fatigue •Depression •Lack of pleasure •Generalized malaise •Anxiety •Vivid and unpleasant dreams •Increased appetite •Irritability •Slowing of activity •Agitation and restless behavior •Sleepiness •Extreme suspicion
  1. Cocaine OD: High blood pressure, fast pulse, increased rate of breathing, agitation, confusion, irritability, anxiety, paranoia, panic, hallucinating, delirium, sweating, seizures (may occur), chest pain, stroke, fever, infection, kidney failure, liver hepatitis, pneumonia, thrombophlebitis.
    1. Cocaine Treatment: Monitor VS every 2 hours with CINA; EKG, oxygen via nasal if SOB or unconscious; benzodiazepines like Ativan (IM or PO) are given to prevent seizures, anxiety, agitation; clonidine for hypertension; IV normal saline is given if dehydrated; acetaminophen or ibuprofen for elevated temp; sodium bicarbonate can be given for tachycardia; defibrillators to restart heart if it stops.
Unsure of events of the last 24 hours; remembered using "unusual" dose IV heroin & cocaine the previous evening. Woke unable to move painful right foot.
K+ 6.5 (hyperkalemia), hypocalcemia, hyperphosphatemia, EKG shows peaked T waves, ABG reveals pH 7.19
1. An elevated potassium level (greater than 5.5mEq/L) aka hyperkalemia. Hyperkalemia greater than 7 mEq/L causes hemodynamic or neurologic conditions. 8.5 mEq/L or greater causes respiratory paralysis, cardiac arrest, or death
  1. Symptoms of hyperkalemia: Frank muscle paralysis, dyspnea, palpitations, chest pain, nausea, vomiting, paresthesia
    1. Peaked T waves are a sign of hyperkalemia with an elevated HR
2. Hypocalcemia is an electrolyte imbalance of low calcium in the blood. Normal levels are 4.5-5.5 mEq/L.
  1. Symptoms of hypocalcemia: Nerves and muscles spasm or twitch, muscle cramps in your legs or your arms, numbness and tingling of your fingers and toes, confused or disoriented,
3. Hyperphosphatemia: levels greater than 5 mg/dL ( adults) and 7 mg/dL (children); normal is 2.5 to 4.5 mg/dL.
  1. Symptoms of hyperphosphatemia:altered mental status, delirium, obtundation, coma, convulsions, seizures, muscle cramping or tetany, neuromuscular hyperexcitability, paresthesia, hypotension, heart failure, prolongation of the QT interval (EKG), cataracts.

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	Created by gurley10 about 10 years ago