This blog aims to disrupt how medical providers and trainees can gain public access to high-quality, educational content while also engaging in a dialogue about best-practices in EM and medical education. We strive to reshape medical education and academia in their evolution beyond the traditional classroom. In those with abdominal pain, particularly left upper quadrant pain, the practitioner should also be concerned about possible splenic infract or splenic abscess from septic emboli (31). One way in which PWID can develop a pneumothorax is through the use of a technique called a “pocket shot.” This technique involves injecting in the supraclavicular fossa in an attempt to reach the jugular, subclavian, or brachiocephalic veins (26).
Infective endocarditis
Talc is a bulking agent that can be injected with IV drugs and can lead to pulmonary talcosis, in which talc particles travel to the pulmonary vasculature and interstitium and cause a granulomatous reaction (27). It can lead to acute respiratory failure, and as the disease progresses can lead to the conglomeration of micronodules into masses, emphysema, chronic respiratory failure, pulmonary hypertension, and right heart failure (27). It can present as diffuse infiltrates or ground-glass opacities on imaging (25). Complications from septic emboli due to infective endocarditis to other organ systems are mentioned throughout this article in their respective sections. According to CDC data from 2014, 27 million people aged 12 or older tried drugs in the last 30 days, about 1 in 10 Americans (3).
Patient-related Factors
Understanding blood-borne complications of iv drug use viral transmission risk was also reinforced as a result of participants’ lived experiences, which subsequently would lead to avoidance of needle sharing practices. This knowledge about safe injection practices was often passed from family members or other friends/acquaintances that injected drugs. Access to prevention services is essential for all persons who inject drugs, who are at greater risk for Viral Hepatitis, HIV, and other infections. Although infections in IDUs can be challenging to manage, they can be satisfying to look after with the right approach. Skin and soft-tissue infections and complications of bacteraemia remain common, but outbreaks of rare infections do occur, so it is essential to remain alert for severe or unusual presentations. Choice of antibiotic therapy is dependent on the organism isolated from blood or sputum and may need to be given for a prolonged period – 4 weeks or more depending on clinical progress.
- On POD 10, his skin edges were closable and so he underwent complex wound closure approximately 20 cm in length.
- The most commonly injected drugs are opioids, but cocaine, amphetamine and amphetamine derivatives, benzodiazepines, barbiturates, or any water-soluble drug may also be injected (1).
- Infections usually affect the arms or legs as these are the sites used most frequently for injection, particularly the antecubital fossa of the non-dominant arm.
- Given the high suspicion for compartment syndrome, the patient underwent compartment pressure testing via Stryker pressure monitor system.
Medical Complications of Injection Drug Use
Aseptic meningitis syndrome generally resolves within several days without sequelae following discontinuance of IGIV. Acute hemolysis, consistent with intravascular hemolysis, reported with IGIV; hemolytic anemia can develop subsequent to IGIV therapy due to enhanced erythrocyte sequestration. VIGIV may contain blood group antibodies that can act as hemolysins and induce in vivo coating of RBCs with immune globulin, causing a positive direct antiglobulin reaction and hemolysis. Individuals with IgA deficiency may develop antibodies to IgA; anaphylaxis could occur following administration of plasma-derived products containing IgA. Severe immediate hypersensitivity reactions to plasma-derived products may occur.
Deep vein thrombosis
You need to check it for patency before you infuse it needed to check it during. If you do run into a problem where you have a VESA count, which is one of those drugs that become extra Bay stated and it’s outside of that tissue, you need to stop the infusion as quickly as possible and notify the provider. PWID are at risk of osteomyelitis of the clavicle and septic arthritis of the sternoclavicular joint due to the “pocket-shot” injection technique and other factors (24, 38). The most common risk factor for sternoclavicular septic arthritis in one study was IV drug use (6, 38). Most of the gastrointestinal complications from IVDU do not appear to be directly linked to IVDU itself or a sequelae of infective endocarditis, but rather seem to be an indirect consequence of the type of drug used itself. For example, opioid use and constipation causing abdominal discomfort, or withdrawal causing nausea/vomiting or diarrhea.
The number of IVDU cases presenting to the emergency department of a single urban center with an upper extremity infection in 2005, 2010, and 2015. We’ve got some tips for people who use drugs to access healthcare and advocate for yourself with healthcare providers – check out Quality Healthcare Is Your Right resource. General symptoms of hepatitis include fatigue, loss of appetite, nausea, mild fever, and muscle aches, and if you smoke cigarettes, you may notice that they taste unpleasant. More severe symptoms of hepatitis include dark (tea-colored) urine, light-colored stools, and jaundice (a yellowing of the skin and the whites of the eyes). The importance of developing long-term relationships with a GP and other members of the healthcare team are perhaps particularly important. Although presentations with multiple problems are commonplace, the priority of the patient may be radically different from that of the healthcare professional at a specific time.
However, although appearing to be very rare, there are a few case reports of septic emboli from infective endocarditis causing mesenteric ischemia (29, 30). IV drugs such as opioids and cocaine may result in non-cardiogenic pulmonary edema (12, 28). Of note, acute opioid withdrawal caused by opioid antagonists such as naloxone may result in non-cardiogenic pulmonary edema and ARDS through a mechanism of massive sympathetic discharge (9). This includes brain abscesses, bacterial and fungal meningitis, and epidural abscesses (6). PWID are also at increased risk of vertebral osteomyelitis/discitis, which can develop into an epidural abscess through local extension (13).
- Of those with septic arthritis, common pathogens include Staphylococcus species (including MRSA), Streptococcus, Pseudomonas, and Serratia species (37).
- The drugs and diluents can increase tissue damage by potentially causing ischaemia, necrosis, vasospasm, and thrombosis.
- An adverse reaction, also known as an adverse event, is an undesirable effect of any health product such as prescription and non-prescription pharmaceuticals, vaccines, serums, and blood-derived products; cells, tissues, and organs; disinfectants; and radiopharmaceuticals.
- Most local health departments offer free tetanus boosters, which will protect you from tetanus for five years, so you should r get one.
- The last one and the most potentially harmful complication that we didn’t run into with IVs is an air embolism.
- They can also reveal pleural effusions, empyema, pneumothorax, hemothorax, or vascular congestion from heart failure; in those with multiple septic pulmonary infiltrates, suspected pulmonary talcosis, or ARDS, a CT of the chest might be warranted (19, 24, 25).
Table 7.12 provides a list of possible complications and related interventions. The first one is an extravasation when extravasation is it’s the leaking of a caustic substance outside of the vessel into the soft tissue space. This is a problem because oftentimes these types of medications will cause tissue necrosis and they have longterm ramifications. Things like surgery or longterm therapies, and what you need to do is anytime you’re giving your patient a potential drug or medication that could cause extravasation, you need to make sure you have a solid IV.
Common Adverse Effects
Monitor closely for clinical signs and symptoms of hemolysis, especially in those with risk factors for hemolysis. In patients considered at higher risk, consider appropriate laboratory testing, including measurement of hemoglobin or hematocrit prior to IV infusion of VIGIV and within approximately 36–96 hours after completion of the infusion. Perform additional confirmatory laboratory testing if signs and/or symptoms https://ecosoberhouse.com/ of hemolysis or a substantial decrease in hemoglobin or hematocrit occurs after the VIGIV infusion. Given the high suspicion for compartment syndrome, the patient underwent compartment pressure testing via Stryker pressure monitor system.
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