Pediatric emergency medicine trisk 3155 3155

contraindicated because of the risk of bag rupture. Instead, decontamination is
confined to administration of activated charcoal and WBI, though in some cases
surgical removal may be indicated. Because cocaine bags and crack vials are
radiopaque in up to 50% of cases, an abdominal radiograph is recommended to
determine the location and extent of retained packets after decontamination has
been initiated. A contrast study or computed tomography scan may be considered
to improve detection.
In the event of severe intoxication or ingestion of more than 1 to 2 g of
cocaine, transfer to the intensive care unit for appropriate monitoring.

Central Anticholinergics
Current Evidence
Increasingly, drugs, plants, and mushrooms with anticholinergic properties are
ingested for their psychoactive effects. Because antidepressants, antihistamines,
antispasmodics, and belladonna alkaloids are in widespread use, these compounds
are more readily available than illicit psychoactive substances. Also, many OTC
drugs possess anticholinergic activity and are ingested to get “high.”
These agents are competitive antagonists with acetylcholine at the
neuroreceptor site ( Table 102.21 ). The major effects of these drugs are on the
myocardium, CNS, smooth muscle, and exocrine glands. The effects of
anticholinergics vary according to the specific drug ingested, particularly because
the many classes of drugs lead to secondary actions that are independent of
anticholinergic actions. An important universal anticholinergic effect, however, is
decreased GI motility. This is associated with delayed absorption of drug and, if
GI decontamination is not performed, the appearance of severe toxicity may be
delayed 12 to 24 hours after ingestion.