Pediatric emergency medicine trisk 3140 3140
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self-harm. Although issues of patient confidentiality may require the physician to
provide limited information to parents, obtaining a thorough psychosocial
evaluation is necessary for complete management of the acute event and
assessment of safety. Such discussions may require or may be facilitated by an
interview with a social worker or psychiatry consultant who can often also assist
with resources and appropriate referrals to substance use treatment programs,
counselors, etc.
SPECIFIC DRUGS
Major categories of drugs of abuse for pediatric providers to be aware of include
(i) psychoactives, including novel psychoactives, (ii) stimulants, (iii) opioids, (iv)
cannabis and synthetic cannabinoid receptor agonists, (v) inhalants, (vi) alcohol,
and (vii) nicotine.
Psychoactives, Including Novel Psychoactives
Dissociatives: Phencyclidine (PCP), Ketamine, Dextromethorphan
CLINICAL PEARLS
The clinical effects of PCP range from inebriation and nystagmus at
lower doses to psychosis, agitation, muscular rigidity, and seizures.
Dextromethorphan intoxication is similar to lower-dose PCP effects,
and may produce a false-positive urine PCP result.
In patients with severe intoxication, clinical evaluation should include
assessment of renal function and the presence of rhabdomyolysis.
