Antedates

Ice antidotes

||Ecstasy poisoning #

@Ecstasy is a semi-synthetic, hallucinogenic substance =(MDMA, 3,4-methylenedioxymethamphetamine). @Its effects range from= nausea, muscle pain, blurred vision, amnesia, fever, confusion, and ataxia to tachyarrhythmias, hyperthermia, hyper/hypotension, water intoxication, DIC, K+↑, acute renal failure, hepatocellular and muscle necrosis, cardiovascular collapse, and ARDS. @There is no antidote and treatment is supportive. Management depends on clinical and lab findings, but may include:=

 Administration of activated charcoal and monitoring of BP, ECG, and temperature for at least 12h (rapid cooling may be needed).  Monitor urine output and U&E (renal failure p293), LFT, CK, FBC, and coagulation (DIC p336). Metabolic acidosis may benefit from treatment with bicarbonate.  Anxiety: diazepam 0.1-0.3mg/kg PO. Max IV does over 2min.  Narrow complex tachycardias in adults: consider metoprolol 5-10mg IV.  Hypertension can be treated with nifedipine 5-10mg PO or phentolamine 2-5mg IV. Treat hypotension conventionally (p778).

JVP

Jugular venous pressure (pulse)
Causes of an elevated central venous pressure
Right ventricular failure
Tricuspid stenosis or regurgitation
Pericardial effusion or constrictive pericarditis
Superior vena caval obstruction
Fluid overload
Hyperdynamic circulation
Wave form
Causes of a dominant a wave
Tricuspid stenosis (also causing a slow y descent)
Pulmonary stenosis
Pulmonary hypertension
Causes of cannon a waves
Complete heart block
Paroxysmal nodal tachycardia with retrograde atrial conduction
Ventricular tachycardia with retrograde atrial conduction or atrioventricular dissociation
Cause of a dominant v wave
Tricuspid regurgitation
x descent
Absent: atrial fibrillation
Exaggerated: acute cardiac tamponade, constrictive pericarditis
y descent
Sharp: severe tricuspid regurgitation, constrictive pericarditis
Slow: tricuspid stenosis, right atrial myxoma