image by: St.Emlyn's

HWN Suggests

Packers and Stuffers: Contraband in the ED

In body stuffers and packers, gastric lavage is ineffective and contraindicated, as the procedure may cause rupture of the packets. Conservative therapy using polyethylene glycol whole bowel irrigation (WBI) is generally recommended in patients with potential toxicity. The most common product, trade named “GoLytely”, (I challenge anyone to come up with a better medical misnomer) is dosed at 1-2 liters per hour. It often requires NG tube administration unless the patient is cooperative. In patients who are extremely agitated, combative or exhibit violent behavior, WBI should be withheld.

read full article

Articles of Interest

Body Packers, Stuffers, and Pushers: Time Bombs in Our EDs

When suspecting body packing, stuffing, or pushing, look for signs of toxicity and abdominal complications. The best diagnostic tool is abdominal CT. X-ray can be used as a screening tool but is far from diagnostic.

Body packers: a plea for conservative treatment

Drug packets in the stomach for >48 h are not an indication for surgery. We recommend that surgery should only be performed in body packers with signs of intoxication or ileus and reserve conservative treatment for all other patients.

Body Stuffers: Can We Do Better?

Imaging does not aid diagnosis in suspected body stuffers. As per previous studies we recommend that body stuffers, require a period of observation for at least 6 h or until asymptomatic, with instruction to return if symptoms develop.

Bodypackers: caught in the act

The number of bodypackers seems to be increasing in the last years. Reliable data about the total number of body packers does not exist, since most probably pass unnoticed through customs and require no medical attention. Since the quality of wrapping the packages has improved, fewer patients present with intoxication but more with abdominal complaints or failure to pass all their packages due to internal obstruction which increases the chance of rupture.

Conservative mangement of asymptomatic cocaine body packers

The best evidence available suggests that asymptomatic cocaine body packers should be managed conservatively till they have completely passed their packets. Close clinical observation in the meantime allows for the early detection of patients developing complications that may require emergency surgery.

Management of body packers in the emergency department

Asymptomatic patients usually present to the emergency department because of custodial request for medical examination and confirmation of body packing. However, there has not been a unified systematic approach to the initial management of asymptomatic body packers.

Packers, Stuffers, and Pushers

Usually the toxidrome will be either sympathomimetic or opioid-related but it could present as a mixed toxidrome depending on the substances that were ingested.

Perspective: Body cavity search warrants. Are they enforceable?

A physician cannot be made an agent of the state for the purposes of law enforcement. If a physician is not advancing the healthcare of a patient, then physicians have no business performing that activity.

Pusher, Packer, or Stuffer? A Case of Pediatric Drug Use

Body stuffers and body packers generally present to health care providers for drug-induced toxidromes, medical assessment after detention or arrest, or intestinal obstruction. The conditions under which the patient presents will often guide the workup and management.

Radiology of body packers: The detection of internally concealed illegal materials

The difference between stool within a gas-filled gastro intestinal tract and ingested drug packets can be subtle. A helpful sign for radiologists is that drug couriers tend to ingest large numbers of packets.

Stuffed, Speeding and Busted!

The patient reported smoking approx 0.5g of crystal meth prior to being interrupted by the police as they entered his home. He had a stash of approx 2-3g crystal meth in a zip-lock bag on table. The police witnessed him swallow the stash, but it was unclear if the bag was sealed.

Resources

Packers, Pushers and Stuffers – Drug Concealment in the ED

Communicate with, but don’t be directed by, the police. You are not obliged to perform intimate examinations or additional imaging if requested by the police. Provide a safe handover of information with safety netting advice.