Evidence-Based Emergency Department Management of Methamphetamine Toxicity (Pharmacology CME)

Enlarge Image
Delivery Method:	Online
$99.00 ADD TO CART OR SUBSCRIBE AND SAVE Back To Store

Publication Date: November 2023 (Volume 25, Number 11)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 11/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credits, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Management of patients who are acutely intoxicated with methamphetamine (a member of the substituted amphetamine class of drugs) can be resource-intensive for most emergency departments. Clinical presentations of the methamphetamine sympathomimetic toxidrome range from mild agitation to rhabdomyolysis, acute kidney injury, seizures, and intracranial hemorrhage. High-quality evidence on how to best manage these patients is lacking, and most research focuses on symptomatic interventions to control patients‘ agitation and hemodynamics. This review analyzes the best available evidence on the diagnosis and management of emergency department patients with substituted amphetamine toxicity and offers best-practice recommendations on treatment and disposition.

Case Presentations

The triage nurse asks you for assistance with an agitated patient who is pacing the floor…

• When you approach the patient, you find an 18-year-old woman who gives you her name but does not respond appropriately to orienting questions. She is cooperative at first, but then starts to become increasingly agitated when you try to obtain further history.
• Her vital signs are: temperature, 37°C; blood pressure, 170/99 mm Hg; heart rate, 120 beats/min; and respiratory rate, 16 breaths/min. She is diaphoretic, but neurologically intact and without any evidence of trauma.
• She becomes uncooperative and starts to threaten the staff. Your attempts at de-escalation with redirection and relocation fail, and you wonder what the best pharmacologic intervention would be...

A 22-year-old man presents after developing chest pain while dancing at a club....

• He admits to taking an “upper,” but says that he is unsure of the specific substance.
• His vital signs are: temperature, 36.6°C; blood pressure, 170/110 mm Hg; heart rate, 115 beats/min; and respiratory rate, 14 breaths/min. His electrocardiogram is negative for ischemic changes.
• He denies any cardiac history or risk factors for pulmonary embolism. You wonder whether this young man needs to have a cardiac workup . . .

A 25-year-old woman arrives via emergency medical services, after having had a seizure…

• The EMTs report that the patient is otherwise healthy and had a witnessed seizure in front of family. Her family denies any prior history of seizure.
• Upon arrival, the patient is disoriented and unable to provide further history. Her vital signs are: temperature, 37.1°C; blood pressure, 190/120 mm Hg; heart rate, 116 beats/min; and respiratory rate, 12 breaths/min.
• You wonder whether her depressed consciousness is due to the seizure or if something else could be going on . . .

Accreditation:

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