Substance Use in Adolescents: Recognition and Management in the Emergency Department (Controlled Substances CME and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: October 2023 (Volume 20, Number 10)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 10/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 3 Controlled Substances CME credits and 2 Pharmacology CME credits, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Adolescent substance use continues to be a prevalent problem and is a cause of morbidity, mortality, and high rates of resource utilization. The variability in presentations of drug intoxication can make accurate identification of the ingested substance, and thus efficient treatment, challenging. This issue provides a review of typical presenting signs, symptoms, and physical examination findings of commonly used drugs. Evidence-based recommendations are offered for a general approach to managing adolescent patients who present with drug intoxication, with specific guidance, when indicated.

Case Presentations

A 16-year-old girl presents with generalized abdominal pain and intractable vomiting…

• The patient has been having 5 to 6 episodes of nonbloody, nonbilious emesis for 2 days and is unable to keep down liquids or solids. The girl denies fever, chills, diarrhea, chest pain, or trouble breathing.
• The girl’s vital signs are: temperature, 37°C; heart rate, 120 beats/min; blood pressure, 135/83 mm Hg; and respiratory rate, 18 breaths/min.
• Upon further questioning privately, she admits daily marijuana use, but otherwise denies use of alcohol and other recreational drugs, as well as sexual activity.
• What are the first steps in diagnosis and treatment of this patient?

You hear EMS is inbound with a 17-year-old boy who was found unresponsive and apneic…

• EMS personnel tell you the boy still has a pulse. Naloxone was administered, with return of spontaneous respirations.
• When the boy arrives to the ED, he is somnolent. His vital signs are: temperature, 36.1°C; heart rate, 50 beats/min; blood pressure, 90/60 mm Hg; and respiratory rate, 6 breaths/min.
• What are the next steps for acute management of this patient?

Your next patient is a 13-year-old boy who was brought into the ED by his parents for agitation…

• The boy’s mom tearfully tells you that he has been more withdrawn the last few months. This evening, he returned from a friend’s home and was very agitated and aggressive. The parents are worried he took some type of drug.
• The boy’s vital signs are: temperature, 37.7°C; heart rate, 130 beats/min; blood pressure, 140/90 mm Hg; and respiratory rate, 22 breaths/min.
• What physical examination findings will help identify a possible ingested substance?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.