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Case 10-1: Marijuana analgesia for a finger injury

Patient Presentation

A young man presented for evaluation of a finger injury.

Figure 10-1.

Finger coated with marijuana as a home remedy for a finger injury

Clinical Features

The proximal interphalangeal joint was swollen and tender to palpation without any deformity. Finger abrasions with minor bleeding were noted. The finger was covered in a fine greenish organic substance which turned out to be marijuana. The patient had applied marijuana to his finger attempting to decrease the pain from his injury.

Differential Dx

  • Fracture

  • Sprain

  • Contusion

Emergency Care

The marijuana was removed (but saved by the patient), and a radiograph was unremarkable. The patient was treated for a sprain of his proximal interphalangeal joint.

Key Learning Points

  • Transdermal marijuana has little systemic effect and no local anesthetic properties.

Further Reading

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Grotenhermen  F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327–360.  [PubMed: 12648025]
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Kupczyk  P, Reich  A, Szepietowski  JC. Cannabinoid system in the skin—a possible target for future therapies in dermatology. Exp Dermatol. 2009;18(8):669–679.  [PubMed: 19664006]
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Tennstedt  D, Saint-Remy  A. Cannabis and skin diseases. Eur J Dermatol. 2011;21(1):5–11.  [PubMed: 21282088]
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Woods  JA, Wright  NJ, Gee  J, Scobey  MW. Cannabinoid hyperemesis syndrome: an emerging drug-induced disease. Am J Ther. 2016;23(2):e601–e605.  [PubMed: 24413371]

Case 10-2: Near escape from restraints

Patient Presentation

A young man who was physically restrained presented to the emergency department (ED).

Figure 10-2.

Physical restraints that had been chewed loose. WA = reinforcing wires

Clinical Features

The patient was agitated, combative, and an imminent danger to self and others.

Differential Dx

  • Psychiatric disease

  • Toxicologic syndrome

  • Central nervous system pathology

Emergency Care

The patient was restrained by hospital security using commercially produced, two-point, reinforced restraint devices (upper arm and contralateral leg), and his agitation required sedation. He settled down and became cooperative. However, he surreptitiously began to chew his way out of his restraints, including the reinforcing wires.

Outcome

The patient’s escape attempt was recognized and thwarted.

Key Learning Points

  • Careful examination of a patient’s clothing and body is necessary with patients who are a danger to themselves or to others. Items that can be a danger to the patient or healthcare providers may be hidden.

  • It is important ...

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