Episode 1 - Beyond The Toxidrome

The Case:

Male in his 20's in the early morning hours unconscious. Upon arrival the patients father came home and found his son unconscious on the living room floor. House is not in disarray, no trauma is noted to the patient, and nothing around the patient. Father states he has no diagnosed medical history, no Rx meds, however years ago the patient struggled with cocaine abuse. Despite such his understanding is the patient has been cocaine free for the last 8 months. States it would be unlikely for him to consume excessive alcohol, no other Rx or recreational drug use, and the fathers Rx meds are all accounted for.

Initial vitals: GCS 3, flushed, sweaty HR 128 Reg, RR shallow 22, SPO2 88% ra, BGL 7.2, 82/54, T37.5C, Pupils sluggish at 4-5mm.

Prehospital 12-Lead ECG here:

If the 12-Lead is not showing properly you can click HERE to open it up in a browser window.

Sympathomimetic toxidrome Clinical features: delusions / paranoia / tachycardia / hypertension / hypotension (severe) / hyperthermia / sweating / piloerection / mydriasis / hyperreflexia / seizures

Useful Links (will open in separate browser windows):

Internet Book of Critical Care - Sodium Channel Blocker Toxicity https://emcrit.org/ibcc/nacb/

Internet Book of Critical Care - Sympathomimetic intoxication https://emcrit.org/ibcc/symp/

StatPearls - Cocaine Toxicity https://www.ncbi.nlm.nih.gov/books/NBK430976/

Medscape - Cocaine Toxicity (free registration required) https://emedicine.medscape.com/article/813959-overview

Life in the Fast Lane - Cocaine Toxicity https://litfl.com/cocaine-toxicity-ccc/