Menaker Jay, Farcy David A, Boswell Sharon A, Stein Deborah M, Dutton Richard P, Hess John R, Scalea Thomas M
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA.
J Emerg Med. 2011 Sep;41(3):e49-53. doi: 10.1016/j.jemermed.2008.02.055. Epub 2008 Sep 26.
"Cocaine-induced agitated delirium with associated hyperthermia" is a rare, almost uniformly fatal syndrome. The incidence of the disease is not known, however, it is believed to have markedly increased since the late 1980s with widespread popularity of crack cocaine.
Recent literature is lacking regarding this rare syndrome. Although almost uniformly fatal, we present a neurologically intact survivor due to a multidisciplinary team approach.
We are reporting a 41-year-old African-American man who arrived at the trauma center with a rectal temperature of 42.6°C (108.6°F) and a toxicology screen positive for cocaine. The patient manifested many of the known complications of cocaine-induced agitated delirium with associated hyperthermia, including renal failure and coagulation panel abnormalities. With early application of cooling techniques, including ice pack, gastric lavage, and bilateral chest cavity lavage using multiple chest tubes, the patient's core temperature was quickly lowered.
This case demonstrated how a multidisciplinary team approach, including emergency medicine and critical care specialists, and aggressive treatment of hyperthermia using bilateral tube thoracostomy and chest cavity lavage enabled our patient's core temperature to be effectively lowered. We were unable to find prior reports of using tube thoracostomy in this manner.
“可卡因诱发的伴有高热的激越性谵妄”是一种罕见的、几乎无一例外致命的综合征。该疾病的发病率尚不清楚，然而，据信自20世纪80年代末快克可卡因广泛流行以来，其发病率已显著上升。
关于这种罕见综合征，近期文献较少。尽管几乎无一例外致命，但我们通过多学科团队方法成功救治了一名神经系统完好的幸存者。
我们报告一名41岁的非裔美国男性，他抵达创伤中心时直肠温度为42.6°C（108.6°F），毒理学筛查显示可卡因呈阳性。该患者表现出许多可卡因诱发的伴有高热的激越性谵妄的已知并发症，包括肾衰竭和凝血指标异常。通过早期应用降温技术，包括冰袋、洗胃以及使用多根胸管进行双侧胸腔灌洗，患者的核心体温迅速下降。
本病例展示了多学科团队方法，包括急诊医学和重症监护专家，以及使用双侧胸腔闭式引流术和胸腔灌洗积极治疗高热，如何使我们患者的核心体温有效降低。我们未能找到此前以这种方式使用胸腔闭式引流术的报告。
