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In the ER, pt VS: HR 150 RR 12 BP 106/77 Temp 103.6 O2 Sat 90 on NRBM

30 y/o male pt who presents to Englewood Hospital ER after being found in bed at a rooming house, unresponsive by Landlord. Noticed to have laxative bottles in floor. As per EMS, pt with poor/shallow respirations, pinpoint pupils Non Rx VS: HR 150 RR 8 BP 136/60 Pulse Ox 86% on NRBM, BS= 127

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In the ER, pt VS: HR 150 RR 12 BP 106/77 Temp 103.6 O2 Sat 90 on NRBM

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  1. 30 y/o male pt who presents to Englewood Hospital ER after being found in bed at a rooming house, unresponsive by Landlord. Noticed to have laxative bottles in floor. • As per EMS, pt with poor/shallow respirations, pinpoint pupils Non Rx • VS: HR 150 RR 8 BP 136/60 Pulse Ox 86% on NRBM, BS= 127 • Given IVF NS, Thiamine 100mg, Narcan 2mg IV

  2. In the ER, pt VS: HR 150 RR 12 BP 106/77 Temp 103.6 O2 Sat 90 on NRBM • Pt received Narcan 2mg IV w/o response • Pt intubated for airway protection • CXR / ABD xray done……pt sent for a Head CT and ABD/Pelvic CT

  3. LABS • ETOH, Acetaminophen, Salicylate , THC , Cocaine, Amphetamines, Barb., Benzodiazepim ( Neg ) • Opiate ( Positive ) • Pt sent to the OR

  4. HEROINENOMA ?

  5. BodyPacking The Internal Concealment of Illicit Drugs

  6. Body packing is a distinct method of drug smuggling. • Surgeons and intensive care specialists will be confronted with body packers when packets do not pass spontaneously and rupture, causing drug toxicity • This mode of transport can have serious medical complications, including drug intoxication--sometimes fatal--as well as intestinal obstruction by foreign bodies (FBs).

  7. In addition to transporting cocaineand heroin, body packers may smuggle marijuana, hashish, amphetamines, or methylenedioxymethamphetamine("ecstasy"),. • Body packers usually carryabout 1 kg (2.2 lb) of drug, divided into 50 to 100 packetsof 8 to 10 g each (0.3 to 0.4 oz) • the drug is denselypacked into a latex sheath, such as a condom or balloon. Thislayer is tied at the open end, covered with several other layersof latex, and sealed with a hard wax coating

  8. Unless the patient is being prepared for immediate surgery,gastrointestinal decontamination should be attempted with Activatedcharcoal, lg perkilogram of body weight (up to 50 g) • Whole-bowel irrigation with a polyethylene glycol–electrolytelavage solution • The use of oil-basedlaxatives shouldbe avoided because they reduce the tensile strength and "burst"volume of latex products

  9. high doses of naloxone may be required to reverse toxicity in body packers. • An appropriate initial dose is 2-5 mg IV, with repeat doses of 2 mg given every 5 minutes until the patient is responsive • The total amount given to achieve a response should then be given every hour as a continuous infusion until all packets have passed.

  10. Successful endoscopic removal of packets from the stomachhas been reported, the risk of packet rupture during the procedurehas led others to caution against it • Packets that are accessibleto the endoscopist most likely represent only a fraction ofthe gastrointestinal burden, and the risk of rupture in removing the packets usually outweighs the benefit.

  11. CT and barium-enhanced radiography are both more sensitive than plain abdominal radiographs • hashish is denser than stool; cocaine appears similar to stool; and heroin has a gaseous transparence.

  12. Consultation with a medical toxicologist or a regional poison-control center is also advised

  13. Eur Radiol. 2005 Jan;15(1):193 • value of abdominal ultrasound for the detection of intestinal drug containers in air travelers suspected of intestinal drug trafficking. • 50 suspects charged with intestinal drug smuggling • portable ultrasound unit (SonoSite 180) was used with a 2- to 4-MHz curved-array transducer • 40 of 42 suspects abdominal ultrasound correctly identified the presence of containers • positive predictive value of an ultrasound examination was 97.6%

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