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Famous people, all who have something in common:
John Belushi, Actor: John was well known as a comedian and actor who had a large following due to his magnetic personality. We all can remember him in the epic film, Animal House. His eating and drinking habits were able to disgust his preppy peers from the ROTC as well as all of the ladies on campus. Who else could drink beer as quickly and efficiently as John? In real life things were pretty much the same, as he was known for his drinking bouts and his use of street drugs. Perhaps he stayed in his role for too long and never was out of character. This lifestyle had an unfortunate endpoint, as eventually it cost him his life. On March 5, 1982, he was found dead in his hotel room at the Chateau Marmont on Sunset Boulevard in the city of the angels. His Medical Examiner listed the cause of death as a lethal injection of heroin and cocaine. John is interred in Abel’s Hill Cemetery, Martha’s Vineyard, Massachusetts.
Chris Farley was another well known actor and comedian. Many times his skits were directed towards his ever increasing girth which along with his antics became his trademark. He was a favorite on Saturday Night Live and kept his audience amused with his personality. Farley, not unlike many other successful actors, had a problem with alcoholism and drug abuse. On Dec 18, 1977, Chris was found dead in his Chicago apartment; his cause of death at autopsy was accidental overdose of cocaine and heroin, with coronary arteriosclerosis as a contributing factor. In the long run his eating habits and his abuse of drugs and alcohol ended his life prematurely. Chris Farley was known as a warm and compassionate individual and was a generous person whose biggest problem was not his lifestyle but the fact that he did not love himself.
These two members of the Actor’s Guild had one thing in common, drug abuse and eventual overdose. What is classified as drug overdose? I would venture to say that it is the absorption of a chemical substance intravenously, orally or through the nasal mucosa in doses significantly higher than intended or prescribed which ultimately disturbed homeostasis to the extent that it created severe illness or death. If caught on time these individuals would be brought to our emergency rooms and classified as OD’s or chemical poisoning. A drug overdose may be intentional or unintentional. It may be used in the acts of suicide or homicide and may just be accidental in nature. Assumptions on our behalf could affect our approach to the patient and could cause us to initiate the wrong treatment. Often head trauma with associated alcohol ingestion is an example of this type of error that could cause the patient their life. Unintentional overdose or poisoning can be the result of an elderly patient who misreads a prescription on a medication bottle because of poor vision or because they have misplaced their reading glasses. Young children who are visiting with their grandparents or other senior citizens can ingest a life threatening dosage of medication because the adult has carelessly loaded their medication box for the week and dropped a pill or perhaps have left medication in an accessible place because they are unaccustomed to infants and toddlers in their homes. These are among the most tragic incidents as the child, their parents and the senior citizen or grandparent all suffer the consequence that can lead to hospitalization and or death from something as innocuous as a beta blocker. Medications left unattended and within the reach of children are “loaded guns” and have the capacity to alter a life forever.
What are the common drugs used in overdose?
Barbiturates lead the list and were most popular in the early 1990’s. In small amounts they produce a state of intoxication similar to alcohol ingestion. Unfortunately, some of those that have used this modality never appreciated the limits or factored in their weight and the potential for overdose problems. Symptoms of overdose include slurred speech, loss of motor coordination and impaired judgment. Depending on dose, frequency and duration of use, the abuser can rapidly develop dependence, both psychologically and physically. The margin of safety between an effective dose versus a lethal dose begins to narrow. This is the form of euthanasia used in the prison system for “death row inmates “who are getting lethal injection. Barbiturates and muscle relaxants or benzodiazepine are used for capital punishment.
“Narcotics” is a Greek word that has its root in the meaning stupor. This heading consists of a variety of substances that induce sleep (a state of narcosis). Among the many used in the United States are opium, opium derivatives and synthetic substitutes. The usual routes are orally, transdermally, injection as well as those recreational drugs that are snorted, skin popped, etc. When observing, a user one will notice watery eyes, a runny nose, excessive yawning, sweating, restlessness, irritability, loss of appetite, tremors, sneezing severe depression, vomiting as well as an increase in both heart rate and blood pressure, spasms, kicking movements from which we assume the term” kicking the habit.” As noted in the examples in the beginning of this article, cocaine and heroin have been huge contributors to the accidental deaths due to cocaine’s ability to create tachycardias and hypertension ultimately causing a cardiac arrest or stroke. The heroin overdoses have been attributed to “bad batches” on the street which lead to cardio-pulmonary collapse.
General Drug Overdose Symptoms
An overdose of drugs will have a systemic effect that represents an increased action of the therapeutic dose. Overdose creates an exacerbation of the side effects of the medication to extreme levels as well as creates additional signs and symptoms that are not described in the accompanying drug literature. When the victim of an overdose as other medial modalities such as heart disease, hypertension, hypotension, diabetes, renal disease, etc, the overdose of a drug can cause severe changes in their cardiac, pulmonary or renal systems and can result in death unless treated immediately. Unfortunately, the receiving hospital emergency room may not have sufficient data to determine the causative effect such as a witness, drugs or drug paraphernalia at the scene or the ability to observe some of the signs and determination of the causative drugs or etiology can be obscured and missed all together. It is imperative to know that health care professionals regardless of their titles do not possess crystal balls and without this object the golden hour elapses and the patient becomes comatose or expires.
The astute medical provider will look carefully at the presenting vital signs and monitor them at fifteen minute intervals for change. The vital signs may be increased or decreased and when in an advanced stage post ingestion, can be absent all together. Associated signs and symptoms will include sleepiness, confusion and coma. It is imperative to remember that as these signs and symptoms occur, that the gag mechanism may become absent and that the patient may regurgitate and aspirate their stomach contents creating a metabolic and pulmonary emergency to add to the stress of recovery. Maintenance of an efficient or a protective airway is essential to prevent additional complications. On presentation the skin may be moist and clammy or dry and warm. Respiratory status may change rapidly with trismus, stridor, wheezing or apnea appearing suddenly. GI effects can be nausea and vomiting, severe abdominal cramping, diarrhea and generalized abdominal pain. Mesenteric ischemia may be a causative effect due to the circulation problem inherent in the overdose. The patient may be hypolvolemic due to vomited blood or blood in a bowel movement and appropriate referral and treatment for shock is necessary. I have personally seen renal failure and hepatic failure due to ingestions of large amounts of otherwise therapeutic drugs.
In closing, this subject is not seasonal but can happen at any time and in any location in the country. This is not an urban problem nor is it neither attributed to various degrees of wealth or poverty nor classified as a male or female problem. There are extremes of age to consider in your treatment, remembering that the very young and the very old are at increased risk of mortality. As a health care provider it is suggested that you review materials related to toxicology prior to treating these events to better prepare yourself to function in the best possible manner and to intervene in the best possible manner.
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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