Anxious Appearing, Suspected Substance Abuse part 2


• Scene – vitals, 20g iv, 2lpm O2

• En route – none

• Hospital – not known


• Response to treatment – able to verbally coach patient and calm her down, decreased her BP en route to 150/90

• Disposition – not known


Elliot Williams, Paramedic Woodburn Ambulance


David Tauber, EMT Editorial Board

David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Marijuana use
• Hypertension

Differential Diagnosis

• Marijuana use

• Hypertension

• CVA/stroke

• Co-ingestion with other agents

• Depression/suicidality

Patient Workup History:

• Patient was having back pain and forgot to get her hypertension medications refilled; did not take meds for 2 weeks, but took 1 today

• Patient had a friend who recommended marijuana tea to treat back pain, gave the patient marijuana; she used a recipe off the Internet to make tea. States that she drank ~1/2 cup.

Physical Exam:

• GCS: 15

• EKG: Sinus tach

• CBG: 155

• Patient is atraumatic. Skin slightly pale. Otherwise unremarkable.

Editor’s Notes

Medic did a nice job of interacting with pt and talking her down to calm her. Additional teaching note: if the marijuana was illicit and from Mexico there is a danger in giving oxygen from interaction with paraquat (trivial name; /ˈpærəkwɑːt/) or N,N′-dimethyl-4,4′-bipyridinium dichloride (systematic name) is the organic compound with the chemical formula [(C6H7N)2]Cl2. It is used as a herbicide sprayed from airplanes in illicit pot control efforts. The farmers immediately harvest after spray plane comes over so as to be able to sell crop. But now it is contaminated. It has been reported to react with increased FIO2 to cause a pneumonitis

~ David Tauber, Director of Paramedic Education, Yale New Haven Sponsored Hospital

Suggested References

Marijuana intoxication


• Gender: Female

• Age: 55 years

• Height: Not Available


• Temperature: Not Available

• Blood Pressure: 192/119

• Heart Rate: 133

• Respiratory Rate: 20

• Pulse Oximetry: 95% RA

Signs and Symptoms

Semi-conscious; nausea; pale, clammy skin

History Medical

• PMH: Back injury 4 years ago

• Allergies: Penicillin

• Dispatch info: 55-year-old female semi-conscious; nausea; pale, clammy skin.


• n/a


• Hyzaar, back pain meds (unknown what)

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