Recreational

Question 1

GHB (gamma-hydoxybutyrate)

Answer 1

• Colourless liquid
• Effects within 20 mins, peaking at 60mins.
• Wildly fluctuating conscious level
  –> Risk is airway obstruction, resp depression, aspiration
• Bradycardia, hypotension only mild

Management is supportive only.

Will abruptly recover at 2-3 hours. May pull a tube.

Question 2

AMPHETAMINES
- Meth, ICE
- Speed
- Ritalin (dex)

Answer 2

R
- Usual

R
- Tolerance-based
- Kids: “one pill can kill”

S
- ANTICIPATE:
- Psych: aggression, paranoia, hallucinations
- Seizure
- Hyperthermia
- Rhabdo
- Hypertensive crises
- Arrhythmia
- Metabolic: Hyper/hypoglycaemia, Hyponatraemia (MDMA)

-SUPPORT:
- BZD, BZD, BZD
–> 5-10mg IV, Q10min (max 60mg)
- Temp >39.5 : I&V
- Refractory HTN:
–> PHENTOLAMINE 1mg IV, 5 minutely (a-blockade, sympathectomy)
–> GTN
- Correct Na, low BSL

I
- 12-lead, BGL, parac (delib)
- Troponin
- UEC
- CK, myoglobin
- CXR
- CTB

D, E, A
No

D
- Observe 4 hours

DON’T USE BETA BLOCKERS - unopposed alpha stim –> malig HTN

Question 3

COCAINE

Answer 3

• Sympathomimetic syndrome
  PLUS
• Na channel blockade

…treat with same principles.