Approach to stimulant use, intoxication, and overdose: Clinical sciences

Stimulants refers to a broad class of medications, supplements, and illicit substances that have sympathomimetic effects on the central nervous system. In general, they can cause increased alertness and wakefulness, elevated mood, enhance cognitive functions like focus and concentration, increase energy levels, and reduce the need for sleep.

Common types of stimulants include amphetamines like dextroamphetamine, methamphetamine, and methylenedioxymethamphetamine, also known as MDMA or ecstasy; as well as cocaine, and caffeine. While pharmaceutical formulations of stimulants are commonly prescribed for the treatment of ADHD and narcolepsy, substances like methamphetamine and cocaine are manufactured and used illicitly for their similar sympathomimetic properties. Caffeine, on the other hand, is the most widely consumed stimulant in the form of coffee or tea for its desired effects of alertness and heightened focus. Regardless of the type and purpose of use, large amounts of these substances can lead to intoxication, overdose, and chronic dependance.

Alright, when a patient presents with a chief concern suggesting stimulant use, your first step is to perform an ABCDE assessment to determine if they are stable or unstable.

If the patient is unstable, stabilize the airway, breathing, and circulation right away. This may require supplemental oxygen or even endotracheal intubation and mechanical ventilation. Next, obtain IV access and consider starting IV fluids. Put your patient on continuous vital sign monitoring, including temperature, pulse, blood pressure, pulse oximetry, respiratory rate, and cardiac telemetry. Additionally, consider using cooling blankets for patients with hyperthermia, and sedation for those with severe agitation.