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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
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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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Pt received Narcan 2mg IV w/o response
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Pt intubated for airway protection
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CXR / ABD xray done……pt sent for a
Head CT and ABD/Pelvic CT
LABS
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ETOH, Acetaminophen, Salicylate , THC ,
Cocaine, Amphetamines, Barb.,
Benzodiazepim ( Neg )
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Opiate ( Positive )
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Pt sent to the OR
HEROINENOMA
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Body Packing
The Internal Concealment of
Illicit Drugs
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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).
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In addition to transporting cocaine and
heroin, body packers may smuggle
marijuana, hashish, amphetamines, or
methylenedioxymethamphetamine
("ecstasy"),.
Body packers usually carry about 1 kg (2.2
lb) of drug, divided into 50 to 100 packets
of 8 to 10 g each (0.3 to 0.4 oz)
the drug is densely packed into a latex
sheath, such as a condom or balloon. This
layer is tied at the open end, covered with
several other layers of latex, and sealed with
a hard wax coating
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Unless the patient is being prepared for
immediate surgery, gastrointestinal
decontamination should be attempted with
Activated charcoal, lg per kilogram of body
weight (up to 50 g)
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Whole-bowel irrigation with a polyethylene
glycol–electrolyte lavage solution
The use of oil-based laxatives should be
avoided because they reduce the tensile
strength and "burst" volume of latex
products
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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.
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Successful endoscopic removal of packets
from the stomach has been reported, the risk
of packet rupture during the procedure has
led others to caution against it
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Packets that are accessible to the
endoscopist most likely represent only a
fraction of the gastrointestinal burden, and
the risk of rupture in removing the packets
usually outweighs the benefit.
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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.
Consultation with a medical
toxicologist or a regional poisoncontrol center is also advised
Eur Radiol. 2005 Jan;15(1):193
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value of abdominal ultrasound for the detection of
intestinal drug containers in air travelers suspected of
intestinal drug trafficking.
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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%