Table 1.
Presentation | Substances implicated | Mechanism | Specific treatment | |
Respiratory compromise | Pneumothorax, haemothorax | Cocaine, cannabis | Barotrauma | Chest drainage |
'Crack lung' | Cocaine | Interstitial and alveolar inflammatory infiltration | Systemic corticosteroid administration | |
Pulmonary oedema | Cocaine | Oxygen, diuretics, nitrates | ||
Interstitial pneumonitis, BOOP | Cocaine | Ventilation where necessary | ||
Chest pain/cardiovascular collapse | Pneumomediastinum, pneumopericardium | Cocaine, cannabis | Barotrauma | Drainage where necessary |
Acute coronary syndrome | Cocaine | Alpha-adrenergic vasoconstriction, platelet aggregation | Sublingual nitrates, benzodiazepines | |
Arrhythmias and sudden death | Cocaine | Sodium channel blockade | ||
Amphetamines | Sympathetic hyperstimulation | |||
Cannabis | ||||
Confusion, convulsions, collapse, coma | With respiratory depression | Opioids, benzodiazepines, ethanol, GHB | Central sedation | Airway protection, ventilation |
With hyponaturaemia | MDMA | Cerebral oedema (excess fluid consumption and ADH release) | Fluid restriction, hypertonic saline administration | |
Predominantly seizure activity | Cocaine, amphetamines | Central nervous system stimulation | Benzodiazepines | |
Opioids, GHB, benzodiazepines, ethanol | Withdrawal | |||
Hyperthermia | With agitated and paranoid behaviour, collapse, and death | Cocaine (excited delirium) | Benzodiazepines, fluid resuscitation | |
In extremis without rigidity | MDMA (exertional hyperpyrexia) | Exertion, dehydration, arousal, environmental warming, alterations in skeletal muscle excitation-contraction coupling | Active cooling ± dantrolene | |
With rigidity | MDMA (serotonin syndrome) | Contraction of antagonistic muscle groups | Paralysis | |
Rhabdomyolysis | With coma | Opioids, benzodiazepines, ethanol, GHB | Pressure necrosis | Fluid administration, monitor for acute renal failure |
With excessive muscle contraction | MDMA | Diffuse tissue disruption | ||
Traumatic | Any | Impaired judgement, risk-taking behaviours |
ADH, antidiuretic hormone; BOOP, bronchiolitis obliterans with organising pneumonia; GHB, gamma hydroxybutyrate; MDMA, 3,4-methylenedioxymethamphetamine