Stimulants such as cocaine, methamphetamine and some synthetic drugs push the body into overdrive, raising heart rate, blood pressure and temperature. Severe agitation and overheating can lead to seizures, heart attack, stroke and death.
Key symptoms
- Agitation, paranoia, hallucinations or violent behavior
- Chest pain, palpitations and a fast heartbeat
- Sweating, hot skin and muscle stiffness
- Headache, seizures or weakness
- Dilated pupils and jaw clenching
What you find on exam
- Scene safety; call extra help for agitation
- Heart rate, blood pressure and core temperature
- Pupils and skin (wet and hot)
- Neurologic signs of stroke
- Injuries from restraint or struggle
Tests
- 12-lead ECG for ischemia and arrhythmia
- Blood glucose
- Hospital: creatine kinase, electrolytes, kidney function, troponin
- Toxicology screen as needed
Treatment basics
- Calm the patient with words; avoid prone or hobble restraint
- Benzodiazepine such as midazolam for agitation, seizures, fast heart rate and high blood pressure
- Active cooling for high temperature: ice packs, wet skin and fans
- IV fluids for dehydration and muscle breakdown
- Aspirin and nitroglycerin for cocaine chest pain per protocol
Red flags
- Temperature above 40 C (104 F)
- Sudden calm or quiet after a violent struggle (possible arrest)
- Chest pain, seizure or one-sided weakness
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.