symtym: Patronizing Dribble

It would seem symtym had the same thought about a recent ACEP News article. I blew it off as more ACEP cluelessness, but symtym has some pointed things to say:

Patronizing Dribble:

In Emergency Medicine, we’re pretty use to being patronized by the other specialties—but I don’t expect it from within the specialty or from the putative leading organization representing emergency physicians. Patronizing dribble? Fluff piece?

Symptoms May Mask Meth Cases in ED | ACEP News | February 2006

Emergency physicians have a lot of catching up to do on their knowledge of the symptoms of methamphetamine addiction, according to Dr. Mark B. Mycyk.

Right, on the most prevalent intoxicant (excluding alcohol of course) in most urban ERs. Where have you been for the past 10 years? Of course, I may be jaded working in Northern California— the meth capitol.

‘Maybe it’s because they don’t know what to do about it, or maybe it’s because they are so focused on traditional drugs of abuse, like cocaine, marijuana, and PCP.

Right, you certainly are showing your regional prejudice—cocaine and PCP have been displaced for several years by methamphetamine use.

Read the rest, and don’t tick off symtym.


  1. I work in Boston. I actually trained with the author of the ACEP News article, who is a toxicologist. I almost NEVER see methamphetamine-related visits. Here, Heroin and Crack cocaine are king. Oxycontin is big too. Meth is very regional. My sister is a physician in Portland (Oregon) and she sees it every day. I’m sure it’s just a matter of time before it comes to Boston.

  2. Northern CA, eh? I’ve heard it’s the drug of choice in Redding and Mt. Shasta areas and I will tell you it is unequivocally the drug of choice in a certain city in Alameda County.

    I could conservatively say that at least 60% of my patients in this one ER, no matter what their presenting complain, had meth in their system.

    I can’t believe that came out of ACEP – I’m going to check out the source blog….what idiots!

  3. Patronizing dribble is correct. I assume everyone has meth in their system. What else explains the chief complaint of “feeling jittery” HA, abdominal pain, migratory numbess, chest pain radiating to right ear and left kneecap

  4. “What else explains the chief complaint of “feeling jittery” HA, abdominal pain, migratory numbess, chest pain radiating to right ear and left kneecap”

    Pulmonary Embolism

  5. Hey, I can’t wait for the next generation of crazy illegal drugs at which time meth will be “old hat”.

  6. As an editor of a Emergency Physicians Monthly for 14 years I can sympathize with the editors of ACEP News when they published a piece that clearly shows a regional bias, but it is still inexcusable. For the last few years I’ve done clinical work as a locums in east Texas where crystal meth is abundant. Before that it was center city Philadelphia where crack was the drug of choice. So many academics, who may have never practiced outside their own region, think that if “they” don’t know it or experience it, the rest of the country must be the same. I’ve learned this isn’t true. EVERYBODY in Texas was an expert in meth diagnosis and treatment, and snake bites, and other problems that I’d see little of. Philly docs could smell crack on a patient. EPM has always worked hard not to have “infomercials” pawned off on the readership as research. It looks like this one might have come a little too close to the line.

  7. sypathies, sympathies; ER physicians much less kocked in the UK; here, I am afraid, it is usually the GPs who have to retreat to the air raid shelter: Every media article on medicine is usually prefaced with a remark…”Your GP probably does not know about.. (insert the condition of the day) make sure you see a specialist.”

    Keep taking the tablets!!


  8. friday night shift says:

    Two casee same evening

    1. Woman smokes crystal meth and drinks two 24’s (oz beer) then climbs into a tree. She falls catching the flabby part of her upper arm on a limb that essentially degloves the upper extremity from her armpit to her wrist. She goes to surgery for repair.

    2. Man smokes crystal meth before going to his job where he climbs ladders and prunes palm trees. (What is it with the trees?) He feels weak and dizzy and drives himself to the ER. On arrival he literally falls out of his car in the parking lot and has a heart rate of 270 and no blood pressure. I zap his ass with some electricity and convert him to an appropriate methamphetamine sinus tachycardia of 130.

    Darwinism is thwarted once again, and two of Americas’s finest are saved so they can continue to reproduce.

  9. I have never seen a meth case that I am aware of, but it seems that they are passing out heroin during home room in high school around here.

  10. Meth is starting to make major inroads down here in Florida… but we had a lot of it where I used to practice.

    We all know how the users get hurt, but if you want to know a little more about it, ask your regional DEA Clan-lab guys to give you a presentation. From an LEO/SWAT standpoint, that information helps one understand the right time to hit a lab… but from a medicine standpoint, it sheds a great deal of light on how the actual cooks get themselves injured/blown-up during the manufacturing process.

    Nasty habit, meth.