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Schmit G, Abdallah FB, Vanhaebost J, P. H. Prise en charge des body-packers. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
>Aujourd’hui, le body-packing ou transport in corpore de substances illicites est le mode de transport de drogues le plus répandu en Europe. Il porte essentiellement sur la cocaïne et l’héroïne, bien que toute autre substance puisse être concernée dans une moindre mesure. Les passeurs (« mules ») sont identifiés par les services de police et de douane sur la base de plusieurs indices permettant de les suspecter, comme l’origine des vols long-courriers, l’abstinence alimentaire, etc. La sensibilité du dépistage urinaire et le diagnostic reposent essentiellement sur l’imagerie abdominale, de préférence l’examen tomodensitométrique lorsqu’il est disponible. Les passeurs sont ensuite placés sous surveillance médicale. Celle-ci n’est pas standardisée, mais devrait durer au moins six heures, avec une attention particulière aux paramètres hémodynamiques et neurologiques. Le risque de rupture des paquets est principalement lié à la qualité de l’emballage. Le traitement est essentiellement conservateur. Les complications restent rares, et le recours à la chirurgie s’avère nécessaire en cas de signes d’intoxication et/ou d’occlusion digestive.
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Abstract
Body packing of illicit drugs is one of the means of drug trafficking. Asymptomatic suspects may be brought in by law-enforcement officers for body search of possible drug packing inside the body. Symptomatic body packers may present with gastrointestinal obstruction or toxicity of the leaking drugs inside the packets. Management strategies are largely determined by the modes of presentation. Asymptomatic persons must be persuaded with every effort for consent to the body cavity search as well as treatment for the safe passage of any packed drugs to avoid possible complications and medico-legal sequelae. Abdominal X-rays and computed tomography can be helpful in confirming the presence of drug packets and in identifying possible packet leakage. Gastrointestinal decontamination, whole bowel irrigation, use of specific antidote as well as operative intervention may be indicated. Emergency physicians must be conversant with the medical and legal aspects of the management of these body packers.
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Alipour-Faz A, Shadnia S, Mirhashemi SH, Peyvandi M, Oroei M, Shafagh O, Peyvandi H, Peyvandi AA. Assessing the Epidemiological Data and Management Methods of Body Packers Admitted to a Referral Center in Iran. Medicine (Baltimore) 2016; 95:e3656. [PMID: 27175693 PMCID: PMC4902535 DOI: 10.1097/md.0000000000003656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The incidence of smuggling and transporting illegal substances by internal concealment, also known as body packing, is on the rise. The clinical approach to such patients has been changed significantly over the past 2 decades. However, despite a recorded increase in body packing in general, there are controversies in the management of these patients. We aimed to gather data regarding the demographic characteristics, treatment, and outcome of body packers, which were that referred to Loghman Hakim Hospital, Tehran, Iran.The data of all body packers admitted to Loghman Hakim Hospital during 2010 to 2014 were evaluated retrospectively. Data regarding the demographic characteristics of the patients, findings of clinical imaging, treatment, and outcome were recorded.In this study, 175 individuals with a mean age of 31 ± 10 years were assessed. The most common concealed substances were crack (37%), crystal (17%), opium (13%), and heroin (6%). According to the results of surgery and imaging (abdominal radiography or computed tomography), the most common place for concealment was stomach in 33.3% and 12% of cases, respectively. Imaging findings were normal in 18% of the individuals. Forty-eight (27%) patients underwent surgery. The main indications for surgery were clinical manifestations of toxicity (79%) and obstruction of the gastro-intestinal tract (17%). The most common surgical techniques were laparotomy and gastrotomy (50%). The mean duration of hospitalization was 3.8 ± 4 days. The mortality rate was 3%.Conservative treatment of body packers seems to be the best treatment method. Careful monitoring of the patients for possible signs and symptoms of intoxication and gastro-intestinal obstruction is strongly recommended.
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Affiliation(s)
- Athena Alipour-Faz
- From the Clinical Research Development Center of Loghman Hakim Hospital (AA-f, MP, OS, HP, AAP); Toxicological Research Center (SS), Excellent Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine; General Surgery Department (SHM), Loghman Hakim Hospital; Community Medicine (MO), Clinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cappelletti S, Piacentino D, Sani G, Bottoni E, Fiore PA, Aromatario M, Ciallella C. Systematic review of the toxicological and radiological features of body packing. Int J Legal Med 2016; 130:693-709. [DOI: 10.1007/s00414-015-1310-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/17/2015] [Indexed: 12/13/2022]
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Alfa-Wali M, Atinga A, Tanham M, Iqbal Q, Meng AY, Mohsen Y. Assessment of the management outcomes of body packers. ANZ J Surg 2015; 86:821-825. [PMID: 26177883 DOI: 10.1111/ans.13226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND The constant need for rapid financial gain drives the international illegal drug industry, which encourages healthy individuals to smuggle drugs through internal concealment. The aim of this study was to evaluate our practice of the management of body packers using a hospital-based protocol in order to validate it. METHODS Electronic hospital data were retrospectively reviewed between 2000 and 2013 of all patients that were admitted to Hillingdon Hospital with a history of internal drug concealment. Demographic as well as clinical data including investigations and management were collected. RESULTS One hundred and twenty patients were admitted over the study period to our surgical unit. This included 86 male and 34 female patients with a mean age of 38 (range 19-64) years. Three per cent (n = 4) underwent surgery for either cocaine toxicity or obstruction. The rest of the patients were managed conservatively with bowel cleansing preparations to encourage the natural passage of drug packages. CONCLUSION Conservative treatment is safe and effective for drug body packers. We therefore recommend conservative management to be the mainstay for body packers with surgery only being indicated on clinical grounds.
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Affiliation(s)
| | - Angela Atinga
- Department of Surgery, Hillingdon Hospital, London, UK
| | | | - Qamar Iqbal
- Department of Surgery, Hillingdon Hospital, London, UK
| | - Aw-Yong Meng
- Department of Emergency Medicine, Hillingdon Hospital, London, UK
| | - Yasser Mohsen
- Department of Surgery, Hillingdon Hospital, London, UK
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Thanacoody R, Caravati EM, Troutman B, Höjer J, Benson B, Hoppu K, Erdman A, Bedry R, Mégarbane B. Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila) 2014; 53:5-12. [DOI: 10.3109/15563650.2014.989326] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shadnia S, Faiaz-Noori MR, Pajoumand A, Talaie H, Khoshkar A, Vosough-Ghanbari S, Abdollahi M. A case report of opium body packer; review of the treatment protocols and mechanisms of poisoning. Toxicol Mech Methods 2012; 17:205-14. [PMID: 20020970 DOI: 10.1080/15376510600992574] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Body packers are people who illegally carry drugs, mostly cocaine as well as opium and/or heroin, concealed within their bodies. The packets are inserted in the mouth, rectum, or vagina in order to get across borders without being detected. In this presentation we report a case of an opium body packer and review the available scientific literature by focusing on mechanisms of toxicity and treatment approach. The patient was a 35-year-old man who had lethargy, respiratory depression, tachycardia, normal blood pressure, hyperthermia, and pinpoint pupils on presentation. No past medical history was obtained and the only positive history was his travel from Afghanistan 2 days earlier, which he had given to emergency personnel before arriving at our hospital. Complete blood cells and kidney and liver tests were all in normal range. In the emergency department, the patient was treated with oxygen, naloxone, and hypertonic glucose. One dose of activated charcoal (1 g/kg) was administered orally. After intravenous injection of naloxone (4 mg), the lethargy, respiratory depression, and miosis were resolved. The patient was admitted to the intensive care unit and 90 min after admission, the patient redeveloped respiratory distress and lost consciousness. He was intubated and mechanically ventilated due to the suspicious of body packing. Plain abdominal x-ray showed multiple packets throughout the gastrointestinal tract; 81 packets were removed by surgery and three of them were left due to leaking. After removing the packets, the patient was treated conservatively. He suffered a pulmonary infection (aspiration pneumonia) and he regained consciousness after 4 days. Upon recovery the patient was seen by a psychiatrist prior to going to prison. Surgery is recommended for body packers who have significant signs or symptoms.
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Affiliation(s)
- Shahin Shadnia
- Loghman-Hakim Hospital Poison Center, Faculty of Medicine, and Toxicological Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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Albertson TE, Owen KP, Sutter ME, Chan AL. Gastrointestinal decontamination in the acutely poisoned patient. Int J Emerg Med 2011; 4:65. [PMID: 21992527 PMCID: PMC3207879 DOI: 10.1186/1865-1380-4-65] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 10/12/2011] [Indexed: 12/15/2022] Open
Abstract
Objective To define the role of gastrointestinal (GI) decontamination of the poisoned patient. Data Sources A computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources. Study Selection and Data Extraction Clinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient. Data Synthesis The literature suggests that previously, widely used, aggressive approaches including the use of ipecac syrup, gastric lavage, and cathartics are now rarely recommended. Whole bowel irrigation is still often recommended for slow-release drugs, metals, and patients who "pack" or "stuff" foreign bodies filled with drugs of abuse, but with little quality data to support it. Activated charcoal (AC), single or multiple doses, was also a previous mainstay of GI decontamination, but the utility of AC is now recognized to be limited and more time dependent than previously practiced. These recommendations have resulted in several treatment guidelines that are mostly based on retrospective analysis, animal studies or small case series, and rarely based on randomized clinical trials. Conclusions The current literature supports limited use of GI decontamination of the poisoned patient.
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Affiliation(s)
- Timothy E Albertson
- Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, California, USA.
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Abstract
BACKGROUND Internal concealment of illicit drugs during international drug traffic represents an important problem in developed countries. These drug traffickers are called "body packers." The aim of this study was to analyze retroprospectively the surgical indications and complications for cocaine body packers and to describe our systematic operative protocol. METHODS From January 1997 to December 2005, 1,181 cocaine body packers were admitted to our Medico-Judiciary Emergency Department. All patients had the same medical surveillance protocol. Nineteen patients required surgical procedure to remove drug packets. RESULTS Thirteen patients had obstruction or intestinal retention (68%). Suspicion of packet rupture or cocaine intoxication occurred in six patients (32%). Zero to three enterotomies were necessary during laparotomy. No deaths occurred. One pouch abscess required relaparotomy and one wound abscess was treated medically. The median hospital stay was 7 days (range: 5-30 days). CONCLUSIONS Few cocaine body packers required a laparotomy. Our systematic operative protocol allowed intestinal clearance and caused acceptable morbidity rate.
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Cawich SO, Williams EW, Simpson LK, Evans NR, Johnson P. Treating cocaine body packers: the unspoken personal risks. J Forensic Leg Med 2008; 15:231-4. [PMID: 18423356 DOI: 10.1016/j.jflm.2007.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 10/13/2007] [Indexed: 11/30/2022]
Abstract
Cocaine trafficking is a significant problem that many Caribbean territories must face. "Body packing" is a common method of transport where the smugglers ingest several cocaine filled packages. Body packers may be taken to hospital when they are detained by law enforcement officers, but occasionally they present on their own or accompanied by persons other than the authorities. This scenario poses a difficult management dilemma in any jurisdiction. We describe our experience with one such case in Jamaica.
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Affiliation(s)
- Shamir O Cawich
- Basic Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica.
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Abstract
Smuggling of illicit drugs by concealing them within the human body (body packer) is a medical-legal issue that has increased in the last few decades. Physicians, especially those working in the emergency department, should be familiar with the diagnostic and therapeutic management -usually conservative management- of this type of patient and their possible complications. The present article reviews the general concepts and physiopathology associated with transport of packages in the digestive tract and describes the experience of a referral hospital with a protocol specifically designed for these patients.
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de Beer SA, Spiessens G, Mol W, Fa-Si-Oen PR. Surgery for body packing in the Caribbean: a retrospective study of 70 patients. World J Surg 2008; 32:281-5; discussion 286-7. [PMID: 18060451 DOI: 10.1007/s00268-007-9316-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Body packing is a way to deliver packages of drugs hidden in body cavities, across international borders. This may cause mechanical bowel obstruction and intoxication leading to emergency surgery. The objective of this retrospective study is to evaluate pre-, per- and postoperative characteristics of body packing and its complications and prognosis after surgery. METHODS Medical information was obtained from 70 patients diagnosed with Body Packer syndrome who underwent surgery for body packing in the period of July 2001-July 2005 at the St. Elisabeth hospital, Curaçao, the Netherlands Antilles. RESULTS Wound infection occurred in 32.9% and fascia dehiscence in 2.9%. Most procedures were enterotomies. One patient had a re-laparotomy for Hartmann's procedure because of an anastomotic leak and three other patients had a partial small bowel resection. The creation of a stoma was only needed in one patient. One patient died of postoperative DIC. In six patients packages were left behind, not requiring re-operation. CONCLUSIONS Bowel obstruction and symptoms of intoxication are clear indications for surgery in body packing patients. In our study there was a low mortality and stoma placement rate, we did find a remarkable high amount of wound infection but no evidence for a higher incidence of fascia dehiscence in comparison with elective gastrointestinal surgery. In surgery for bodypacking a mandatory postoperative x-ray is indicated. A prospective trial is needed to assess more information about possible predictive factors of postoperative complications and mortality after surgery for body packing.
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Affiliation(s)
- S A de Beer
- Rijnstate Hospital, Wagnerlaan 55, Arnhem, the Netherlands.
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Guinier D, Hubert N, Chopard JL. [Surgical and forensic problems of body-packing]. JOURNAL DE CHIRURGIE 2007; 144:481-485. [PMID: 18235358 DOI: 10.1016/s0021-7697(07)79772-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Body-packing has increased as a means of illicit drug transportation, particularly since the intensification of customs control and luggage inspection which followed the terrorist attacks of September 11, 2001. This mode of drug transport may result in intestinal obstruction or systemic intoxication; diagnostic measures are discussed; management may require specific precautions and occasionally surgical intervention. The problem of how to handle and dispose of large quantities of drugs removed from or passed by a patient who may not be under arrest presents specific medicolegal considerations.
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Affiliation(s)
- D Guinier
- Service de Chirurgie Viscérale, Hôpital Louis-Pasteur, CHG - Dole.
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Abstract
BACKGROUND "Body packing" of illegal drugs has increased in the last decades, and with it our experience in treating these patients, yet no clear guidelines for surgical treatment are available. We examined the characteristics and outcomes of patients who required surgical intervention. STUDY DESIGN Charts of all patients who underwent surgery at our institution for ingested drug packets between January 1990 and January 2005 were reviewed. Patients were identified by a pre-existing list of names collected prospectively and by admission codes. Reviewed parameters included presentation, method of diagnosis, indication for surgery, procedure, and patient outcome. RESULTS Twenty-five patients were identified, for whom charts were available for review. Main indications for surgery were drug toxicity and small bowel obstruction. Most packets were retrieved using a combination of milking and multiple enterotomies. A high rate (40%) of postoperative wound infection was found. The incidence of wound infection correlated significantly with the number of enterotomies. CONCLUSION Surgical intervention for body packing remains the treatment for a minority of these patients. Patients should be placed in lithotomy to facilitate the exposure of the entire gastrointestinal tract, and to allow milking of the packets and their possible retrieval through the anus. The number of enterotomies should be minimized in order to reduce the risk of wound infection. If multiple enterotomies are used, the surgeon should consider leaving the wound open for delayed closure.
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Affiliation(s)
- Daniel Silverberg
- Department of Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
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Abstract
The case of a 6-year-old boy presenting with severe clinical manifestations of an opioid intoxication and who is discovered to be an international "body packer" is presented and discussed. This article is the first to report on the phenomenon of body packing in young children. It also highlights the use of prescription opioids as cargo, which has not previously been addressed in the literature.
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Affiliation(s)
- Suzanne Beno
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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de Prost N, Lefebvre A, Questel F, Roche N, Pourriat JL, Huchon G, Rabbat A. Prognosis of cocaine body-packers. Intensive Care Med 2005; 31:955-8. [PMID: 15909167 DOI: 10.1007/s00134-005-2660-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Accepted: 12/17/2004] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To study the prognosis and complications of cocaine body-packing (concealment of cocaine in the body for transportation between countries). DESIGN We retrospectively reviewed the files of all cocaine body-packers hospitalized during a 4-year period in a medico-judiciary emergency unit. Subjects included in the survey were identified from the hospital databases using ICD-10 codes. SETTING The Medico-Judiciary Emergency Unit of Hôtel-Dieu university hospital in Paris is a unique medical and surgical emergency unit receiving all patients in legal custody arrested at the two Paris international airports and suspected of body-packing. PATIENTS All the cases of cocaine body-packers (n=581) hospitalized between January 1999 and December 2002 were studied. They had been arrested at Paris airports while arriving from drug-producing countries. RESULTS The mean number of carried packets was 70.0+/-20.4 (range 18-150). The mean duration of hospitalization was 5.0+/-1.6 days (range 1-18). No complication occurred in 573 body-packers cases. Eight subjects developed a complication requiring admission to an intensive care unit: six acute cocaine intoxications due to packet rupture and two intestinal occlusions. No one died. Surgical treatment was necessary in six cases. CONCLUSIONS Good prognosis observed in these body-packers cases is due to the careful monitoring of asymptomatic patients, allowing early detection and treatment of complications. Surgical removal of the packets when complication occurs is warranted.
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Affiliation(s)
- Nicolas de Prost
- Respiratory and Intensive Care Unit, Hôtel-Dieu, 1 Place du Parvis de Notre-Dame, 75004, Paris, France
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Abstract
Whole bowel irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that WBI improves the outcome of the poisoned patient. Based on volunteer studies, WBI should be considered for potentially toxic ingestions of sustained-release or enteric-coated drugs particularly for those patients presenting greater than two hours after drug ingestion. WBI should be considered for patients who have ingested substantial amounts of iron as the morbidity is high and there is a lack of other options for gastrointestinal decontamination. The use of WBI for the removal of ingested packets of illicit drugs is also a potential indication. WBI is contraindicated in patients with bowel obstruction, perforation, ileus, and in patients with hemodynamic instability or compromised unprotected airways. WBI should be used cautiously in debilitated patients or in patients with medical conditions that may be further compromised by its use. The concurrent administration of activated charcoal and WBI may decrease the effectiveness of the charcoal. The clinical relevance of this interaction is uncertain. A review of the literature since the preparation of the 1997 Whole Bowel Irrigation Position Statement revealed no new evidence that would require a revision of the conclusions of the Statement.
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Mokhlesi B, Garimella PS, Joffe A, Velho V. Street drug abuse leading to critical illness. Intensive Care Med 2004; 30:1526-36. [PMID: 14999443 DOI: 10.1007/s00134-004-2229-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2003] [Accepted: 10/15/2003] [Indexed: 11/26/2022]
Abstract
Critical care physicians are frequently confronted with intoxicated patients who have used street drugs. In the last decade there has been an upward trend in the use of these substances, particularly amongst adolescents and young adults in large urban areas. In excess quantities all street drugs can lead to critical illness. Early and appropriate medical attention by emergency medicine physicians and intensivists can improve outcomes. In this review article we intend to familiarize critical care physicians with the most common street drugs such as amphetamines, ecstasy, cocaine, gamma hydroxybutyrate, opioids, and phencyclidine.
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Affiliation(s)
- Babak Mokhlesi
- Division of Pulmonary and Critical Care, Cook County Hospital and Rush Medical Center, 1901 West Harrison Street, Suite 2818 B, Chicago, IL 60612, USA.
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Affiliation(s)
- Stephen J Traub
- Department of Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, USA.
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Abstract
Some toxicologic emergencies require immediate or urgent surgical intervention in addition to routine medical care. The EP must be familiar with the indications for operative care, even though many of these poisonings and exposures are relatively rare. The EP must also be knowledgeable regarding the various means of surgical decontamination that are available, including temporary cardiopulmonary bypass. Finally, a high level of vigilance must be maintained for patients who have delayed presentation and fulminant organ failure necessitating early involvement of the transplantation team.
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Affiliation(s)
- Ashok L Jain
- Department of Emergency Medicine, LAC + USC Medical Center, Keck School of Medicine, 1200 N. State Street, Los Angeles, CA 90033, USA.
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