Drugs Of Abuse: Providing The Best In Evidence-Based Care To “Self-Medicated” Patients

Del Rios, Marina MD
Lanigan, Michael MD
Zayas, Vincent MD
Freeman, Lisa MD, FACEP
Jagoda, Andy MD, FACEP

¹ Authors
² Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center—New York, NY.
³ Assistant Medical Director, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center—New York, NY.
⁴ Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center—New York, NY.
⁵ Peer Reviewers
⁶ Assistant Professor, Department of Emergency Medicine, University of Texas Medical School at Houston—Houston, TX.
⁷ Professor and Vice-Chair of Academic Affairs, Department of Emergency Medicine; Residency Program Director, Mount Sinai School of Medicine— New York, NY.

Date of original release: May 17, 2005.

Date of most recent review: May 15, 2005.

See “Physician CME Information” on back page.

Emergency Medicine Practice 7(5):p 1-22, May 2005.

It's the wee hours of a Sunday morning — or very late on a Saturday night, for some. The ED is finally quieting down. Just as you are about to have a seat and rest your sore feet, the ambulance bay doors swing open. On a stretcher, a 55-year-old woman appears, clutching her chest and clearly diaphoretic. She does manage to tell you that she has a history of hypercholesterolemia and hypertension and is not compliant with her medications. She received nitroglycerin and aspirin en route to the hospital, but with minimal relief.

The paramedics begin describing what they observed when they picked her up, but you are suddenly distracted by an alarm on the monitor. Her blood pressure is 190/110, and she is in sinus rhythm at 140 beats per minute. You need to lower that blood pressure and heart rate! A technician hands you an electrocardiogram with ST tombstones on the lateral leads, and you ask a nurse for a vial of metoprolol. You have only administered 5 mg of this medication, when suddenly the patient's blood pressure shoots up to 210/120, and she is clutching her chest and looking more anxious. The paramedics then tell you that they had observed several pipes and syringes lying around in her room.

Within seconds, the patient loses consciousness, and the monitor shows a ventricular tachycardia.