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We learned about club drugs in class recently. It's a subject I have interest in from my former career. Here are some case studies from a conference I attended. See if you can correctly identify which substance the patient might have ingested.
Case 1
18 year old female college freshman brought into ED after tripping on the way home to the dorm after a party at a house off campus. She is complaining of right ankle pain. You notice that her speech is slurred and seems to go to sleep every time you stop talking to her. Physical exam findings: CNS depression, dysconjugate gaze, nystagmus, pupils normal to small.
Case 2
18 year old male presents to the ED at about 3 am after being at a ‘rave'
He is staring off into space, clenching his jaw, and trying to hug the nurse as she starts an IV. Nurse has difficultly starting the IV due to patient's dehydration. You notice his pupils are enlarged and he is tachycardic, he grabs your pen light and starts into it and moves it around in circles. His body temperature is elevated.
Case 3
21 year old male presented after being "found down" by the police
He is not responding to your questions. His extremities are rigid
He is tachycardic, hypertensive and his temperature is 104.5 F. He is placed on a ventilator, a cooling blanket and given sedatives.
Case 4
At about 4 am on a Saturday night, EMS brings in 4 patients all about 20 year old who have been at a ‘rave'. The first is unresponsive and not breathing and is placed on ventilator support. The second is unresponsive but breathing ok. The third is agitated and shouting then slips into a coma
The fourth is awake and says they were doing…
Case 5
24 year old female brought in after being found passed out at a party
Her friends say she wasn't drinking but may have been taking some pills but don't know what. The patient is sleeping peacefully, she awakens momentarily to painful stimuli.
Case 6
15 year old high school girl is dropped off at hospital by friends after a Rave party. Found sitting in bathroom spaced out. Physical exam findings: Confused
Starring off into space, rotatory nystagmus, tachycardic, slight diaphoresis, mental status clears over next hour.
Choices include: cocaine, alcohol, MDMA, Ketamine, GHB and benzodiazepines. Could be other drugs as well.
These case studies were written by A. Humbert, an MD practicing emergency medicine in Indianapolis, IN.
Case 1
18 year old female college freshman brought into ED after tripping on the way home to the dorm after a party at a house off campus. She is complaining of right ankle pain. You notice that her speech is slurred and seems to go to sleep every time you stop talking to her. Physical exam findings: CNS depression, dysconjugate gaze, nystagmus, pupils normal to small.
Case 2
18 year old male presents to the ED at about 3 am after being at a ‘rave'
He is staring off into space, clenching his jaw, and trying to hug the nurse as she starts an IV. Nurse has difficultly starting the IV due to patient's dehydration. You notice his pupils are enlarged and he is tachycardic, he grabs your pen light and starts into it and moves it around in circles. His body temperature is elevated.
Case 3
21 year old male presented after being "found down" by the police
He is not responding to your questions. His extremities are rigid
He is tachycardic, hypertensive and his temperature is 104.5 F. He is placed on a ventilator, a cooling blanket and given sedatives.
Case 4
At about 4 am on a Saturday night, EMS brings in 4 patients all about 20 year old who have been at a ‘rave'. The first is unresponsive and not breathing and is placed on ventilator support. The second is unresponsive but breathing ok. The third is agitated and shouting then slips into a coma
The fourth is awake and says they were doing…
Case 5
24 year old female brought in after being found passed out at a party
Her friends say she wasn't drinking but may have been taking some pills but don't know what. The patient is sleeping peacefully, she awakens momentarily to painful stimuli.
Case 6
15 year old high school girl is dropped off at hospital by friends after a Rave party. Found sitting in bathroom spaced out. Physical exam findings: Confused
Starring off into space, rotatory nystagmus, tachycardic, slight diaphoresis, mental status clears over next hour.
Choices include: cocaine, alcohol, MDMA, Ketamine, GHB and benzodiazepines. Could be other drugs as well.
These case studies were written by A. Humbert, an MD practicing emergency medicine in Indianapolis, IN.
