II. Definitions

  1. Body Stuffer
    1. Ingestion of Illicit Drug packets to spontaneously hide their contents (e.g. while being arrested by police)
  2. Body Packer (Drug Mule)
    1. Ingestion of large quantities of professionally wrapped and secured Illicit Drugs (i.e. Drug Smuggling)
  3. Body Pusher
    1. Illicit Drug packets inserted into Rectum or vagina

III. Precautions

  1. Course is unpredictable
  2. Variable quantity of ingested substance
  3. Variable packaging of substance (and potential for absorption)

IV. Diagnostics

  1. Imaging, endoscopy and surgery are not typically indicated

V. Management

  1. Detoxification
    1. Offer to all awake, alert, cooperative patients (including asymptomatic patients)
    2. Activated Charcoal 1 g/kg or at least 50 g
  2. Symptomatic Patients
    1. Treat based on Toxidrome of ingested substance
    2. Admit all symptomatic patients
  3. Asymptomatic patients
    1. Observe for at least 6 hours
    2. Consult with poison control
      1. Some will recommend 12 hour observation for certain suspected substances (e.g. Fentanyl-laced)
  4. Leaving Against Medical Advice
    1. See Against Medical Advice
    2. See CURVES Capacity Assessment Tool
    3. Provide Informed Consent regarding risk of life threatening consequences related to their ingestion
    4. Patients with Decision-Making Capacity may refuse treatment and be discharged per their wishes

VI. References

  1. Swadron and Nordt in Herbert (2021) EM:Rap 21(9): 3-4

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