Drugs Intoxications
Basic Olicognograph: Organic Semiology
Our purpose is not to make improvise yourself a physician or an hospital doorservice toxicologist but to care the risks and complications of clinical managment and have the first steps adapted reactions, in suspescted acute intoxications: refer and/or call. General means are usefull to any, even if they are often sufficient do not think so in unsafe without means environments. Care especially opiates, cocaine-crack, alcohol and psychedelics club-drugs (not very addictive) by the behavior they can produce and when combined with other products or dirty drugs. So waiting and whenever possible: safe, secured calm environment, freshness, balance drinks, (not too much sugar), follow up especially of temperature, information gathering, prevention of unsure interpretations and call emergency services are good general means.
Cocaine-crack intoxication is a common problem in emergency departments. Morbidity and mortality in cocaine abusers are accentuated by co-ingestion of illicit drugs (heroin), alcohol and nicotine. Potentially fatal complications of cocaine abuse include delirium, hyperthermia, myocardial infarction, stroke, intracerebral bleeding or acute renal failure due to rhabdomyolysis (muscle destruction). Non-selective beta-adrenergic receptor antagonists are contraindicated in the treatment of cardiovascular complications associated with cocaine abuse. Selective beta-blocking agents are not recommended. Benzodiazepines are effective as first line treatment for cocaine-related clinical symptoms such as delirium, hyperthermia, hypertension and tachycardia.
Opiates intoxication-overdosis is also extremelly serious and should care especially respiration-oxygenation. Homeostasis: that inner body general medium equilibrium (a somehow abstract concept) may fail in drugs intoxications. Signs to care: hyperthermia, neuropsychiatric conditions (confusion, delirium), bleeding. A rare complication of most club drugs and/or stimulant (cocaine-crack) but with mortal prognosis and enhanced by multiple consumption (alcohol and other drugs).
Withdrawal from strongly physiological addictive substance as opiates and alcohol are dangerous especially alcohol. 1) acute and chronic effects of alcohol may differ substantially; 2) dose-dependent effects of alcohol are often overlooked; 3) changes induced by alcohol’s metabolic products (e.g., acetaldehyde) and other ingredients of alcoholic beverages are difficult to evaluate; 4) alcohol has clear neurotoxic effects, resulting in cell damage; 5) few studies have been conducted in long-term abstinent alcoholics or high-risk patients.
Care that if lot of information can be found in documents and table we provide here, in clinics out of body ressources, nothing replace the practical experience. Otherwise you may find yourself with dangerous complications in place and moments with not means and where the only that will remain (together with someone dying) is why you have not recognize your limits and have not refered or called sooner. Circumstances where and when you are the lone captain with on board means, almost does not exist more: movies lie.
Finally, introducing to next table we summarize the sort of drugs/alcohol chronic intoxication risks and pregnancy risks. Also with some special philosophy of commited humanist, we do not like much the sort of very improbable and extraordinary information pretending to afraid you as far as possible of all hardest issues on drugs abuse disorders; there is a balance to make between rarity and practical things that you may face, because enough probable. May be psychiatric co-morbidities are effectively the "big horrendous things" to prevent, but they are hard to understand and are still stigmatized after they happened, in the course of addiction ("he/she looks so like you and me but when we start to speak to him/her...") or so rooted in the mispractices of deculturized - modern culture habits, rejected on the "shamefull weakness of desserving loosers". In the table, care the meaning of our signs: less as negative to the person.
Common Psychotropics Drugs Organic Effects (intensity of negative effect on the item: (- : negative probable or indirect) ( - - - : very noxious) |
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|
Alcohol |
Heroin opiates |
Cocaine crack |
Ectasy MDMA amphe -tamines |
Cannabis Marijuana Hashish |
LSD |
Solvents |
Benzo diazepine |
|
immunologic |
- - |
|
|
|
( - ) |
|
|
|
|
lung, pulmonary |
( - ) |
|
- - - smoke |
|
- - - smoke |
- - - |
|
|
( - ) |
liver |
- - - |
|
|
|
|
- |
|
- - |
|
digestive |
- - - |
|
- |
|
) |
( - ) |
|
|
|
mouth |
- - |
- - |
|
|
( - ) |
- - |
|
( - ) |
|
nasal |
- - |
- - |
- - |
|
( - ) |
- - |
|
( - ) |
|
skin |
|
- - injec. |
( - ) |
|
|
|
behavio -ral |
- |
|
central nervous system |
- - - |
- - depres. |
- - |
- - |
|
|
risks |
|
|
psychiatric |
- - |
- |
- - |
- |
( - +) |
- |
|
|
|
cardiovascular |
- - |
- |
- - - |
|
( - ) |
- - |
|
|
|
reproduction |
- |
|
( - ) |
|
( - ) |
( - ) |
|
|
|
small low birth weight |
- |
- |
( - ) |
|
( - ) |
- |
|
|
|
abortion |
- |
- |
( - ) |
- |
|
- |
|
|
|
born dead |
|
|
|
|
|
|
- |
|
|
preterm delivery |
|
- |
- |
|
|
|
|
|
|
embryo fetopathy |
- - - |
|
|
|
( - ) |
|
|
|
|
baby withdrawal Sd at birth |
|
- - - |
- |
|
( - ) |
|
|
|
- - |
sudden death Sd |
- |
- |
( - ) |
|
( - ) |
|
|
|
|
