Barotrauma related to inhalational drug abuse

Seaman, Matthew

doi:10.1016/0736-4679(90)90223-i

Cited by 67 publications

(39 citation statements)

References 48 publications

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“…In the present case, presence of mediastinal air was most likely due to positive pressure or prolonged Valsalva maneuvers that trigger microscopic esophageal tears, finally causing air leakage into the mediastinal space, as supported in the literature [7,8]. We believe that in the present case, the cause of SPM was not pharmacological or dose related but related to the Valsalva maneuvers associated with the vomiting induced by the drug [9,10].…”

Section: Discussionsupporting

confidence: 55%

A Rare Cause of Spontaneous Pneumomediastinum: Ecstasy Ingestion

2015

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Ecstasy ingestion has life-threatening effects such as hyperpyrexia, rhabdomyolysis, disseminated intravascular coagulation, coma, and death. In the present report, we aimed to highlight ecstasy as a rare cause of spontaneous pneumomediastinum and its potential lifethreatening effects. A 16-year-old female with dyspnea and chest pain presented to the emergency department. Chest computed tomography demonstrated pneumomediastinum at the level of the thoracic inlet and upper and posterior mediastinum. The patient was admitted to the thoracic surgery department with a preliminary diagnosis of spontaneous pneumomediastinum. She refused to answer any questions during the first visit, an a psychiatric consultation was requested. The most important finding of psychiatric consultation was ecstasy abuse, which could not be identified in the emergency department evaluation. Four days later, the symptoms resolved completely and control chest X-rays showed no complications; therefore, the patient was discharged. While investigating the etiology of spontaneous mediastinum, particularly in a young, healthy patient, ecstasy abuse should always be considered. Because the fatal complications that may develop due to ecstasy ingestion may be overlooked. KEY WORDS: Pneumomediastinum, ecstasy, dyspnea INRODUCTIONSpontaneous pneumomediastinum (SPM) is the existence of free air within the mediastinum without any known precipitating events, such as trauma, surgery, or medical procedures. Although it is a rare, usually benign, and self-limited condition, it is very important to detect the causes that trigger pneumomediastinum, such as exacerbation of asthma, tobacco, use of inhaled drugs, corticosteroids, emesis, cough, physical exercise, labor, and also abuse of recreational drugs such as cocaine and ecstasy [1,2]. CASE PRESENTATIONA 16-year-old female living in an orphanage presented to the emergency department with dyspnea and chest pain. Physical examination, electrocardiogram, routine laboratory tests, and chest radiograph were all unremarkable. Chest computed tomography established pneumomediastinum at the level of the thoracic inlet and upper and posterior mediastinum (Figure 1). The patient was evaluated by a general surgeon, otolaryngologist, gastroenterologist, and thoracic surgeon. Endoscopic evaluations (esophagoscopy, laryngoscopy, and bronchoscopy) revealed no esophageal or upper respiratory tract pathologies. The patient was admitted to the thoracic surgery department with a preliminary diagnosis of SPM for follow-up. The vital signs were stable (blood pressure: 120/74 mmHg, pulse rate: 74 beats/min, temperature: 36.5°C, respiratory rate: 20 breaths/min, oxygen saturation: 95%). The patient refused to communicate with the doctor or answer any questions during the first visit, and psychiatric consultation was requested. Psychiatric consultation revealed that the patient had been placed in the orphanage 3 years ago. Since then, she would become angry at everything and damage her surroundings; she was therefore taking antidep...

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Section: Discussionsupporting

confidence: 55%

A Rare Cause of Spontaneous Pneumomediastinum: Ecstasy Ingestion

2015

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“…Certainly, pneumomediastinum has been reported as an acute complication of other inhaled illicit drug use. 19 Spontaneous pneumomediastinum is an unusual presentation to hospital estimated to occur in 1 in 3400 emergency department admissions. 20 It can occur as the result of any activity involving the Valsalva manoeuvre such as coughing, sneezing, vomiting, exercise, childbirth, pulmonary function testing, and has also been reported as a complication of asthma, diabetic ketoacidosis, mechanical ventilation, endotracheal intubation and endoscopy.…”

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confidence: 99%

Ecstasy-Associated Pneumomediastinum

Marasco

Lim

2007

annals

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INTRODUCTION Ecstasy, also known as MDMA (3,4, methylenedioxymethamphetamine), is a popular illicit party drug amongst young adults. The drug induces a state of euphoria secondary to its stimulant activity in the central nervous system. PATIENTS AND METHODS A database review at two major inner city hospitals was undertaken to identify patients presenting with pneumomediastinum and their charts reviewed. A Medline review of all reported cases of pneumomediastinum associated with ecstasy abuse was undertaken. RESULTS A total of 56 patients presenting with pneumomediastinum were identified over a 5-year period. Review of the charts revealed a history of ecstasy use in the hours prior to presentation in six of these patients, representing the largest series reported to date.CONCLUSIONS Review of previously reported cases reveals the likely mechanism is due to Valsalva manoeuvre during periods of extreme physical exertion, and not a direct pharmacological effect of the drug. KEYWORDSMediastinal emphysema -N-Methyl-3,4-methylenedioxyamphetamine -Ecstasy

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“…Thedevelopmentofmediastinalairispresumably related to positive pressure or prolonged Valsalva manoeuvers that induce microscopic oesophageal tears, eventually producing air leakage into the previously self-contained mediastinal space. 2,3,6 Clinical signs and symptoms resulting from cocaine-induced pneumomediastinum depend on the amount of mediastinal air present. Crack cocaine users may experience acute non-specific respiratory problems, including cough, shortness of breath, haemoptysis, and chest pain.…”

Section: Discussionmentioning

confidence: 99%