Trying to avoid arrest for drug possession, some people will swallow the evidence. The police bring these suspects to the emergency department because it is well understood (to everyone except the suspects, I guess) that this can be dangerous.
Recently, I had just such a patient. He was twenty-four-years-old and had swallowed small plastic bags containing crystal methamphetamine. He was OK when he arrived, but we have had such patients go on to die, so, we take it very seriously. This young man gradually got agitated, his blood pressure and pulse went up, and he became confused and combative.
There is no antidote for meth overdose. Our treatment was focussed on two things: flushing his system of any meth not yet absorbed and giving sedatives to control the agitation, high blood pressure and racing pulse caused by the drug.
Since the little packets keep releasing more and more meth as they pass through the intestines, we try to get it out of the intestines before it can be absorbed into the blood stream. This is done by a technique called “whole bowel irrigation.”
First, we placed a tube through the patient’s nose into his stomach. Through it, we pump the same solution used as a bowel prep for a colonoscopy. As the fluid passes down the intestine, it causes large volumes of watery diarrhea. In preparation for a colonoscopy, the solution clears out all the stool so the GI doctor can see the inside of your guts. In this case, we were hoping to wash the drugs out before they could be absorbed and cause the patient more trouble – maybe even death.
Though the patient seemed normal when he first came to the ED, he was soon thrashing around, out of control. He was sweaty and fighting against all our efforts to control him. Because of this, it was hard to start an IV, and even after we managed that, he pulled it out. We reinserted the IV and then secured his arms and legs to the bed with leather restraints. I ordered sedatives to help his body relax, but in these situations, there is no way to know just how much medication is needed to overcome the effects of the meth. I just continued to order more sedatives until we saw the desired effects. This is tricky as there is a serious risk of over-sedation, so we kept a very close watch on him.
A patient like this would usually be transferred to intensive care as soon as initial treatment and stabilization were preformed. On this particular night, all of the ICU beds were full so he couldn’t go upstairs. We might have transferred him to another hospital, but he was under arrest and we are the county hospital that cares for all local inmates. So, he stayed in the emergency department all night.
As night passed, the sedatives caused him to sleep, unless he was touched or moved. When that happened, he again thrashed around and screamed at the top of his lungs. The problem was that once the bowel irrigation started to take effect, he had a huge stool in the bed. The nursing staff had to roll him to clean him up, and he screamed and fought the whole time they touched him. I gave him more sedatives and, once cleaned up and left alone, he fell back asleep. A little later, he pooped again, and the whole scene would repeat itself. Eventually, all that came out if his butt was clear water which was more pleasant for the staff to clean up, but he still screamed and flailed around every time his bedding had to be changed.
The next day, he woke in our emergency department as if nothing had happened and went off to jail. He will never have any memory of the care we gave him to prevent the potential deadly consequences of swallowing the evidence.
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