Asymptomatic patients
Expectant management, no surgery, close monitoring in ICU until passage of all packets
Whole bowel irrigation with polyethylene glycol via NGT at 2L per hour
Activated charcoal more useful in<unk>  stuffers
Opioid toxicity
Naloxone: may require very high doses
2 to 5mg IV initially, repeat 2mg q5min until responsive
then total amount required for response should be given every hour as continuous drip
Sympathomimetic toxicity
Immediate OR for surgical decontamination
No place for conservative management
Pharmacologic stabilization appropriate but not definitive, do not delay transfer to the OR
Hyperthermia
Active external cooling
IV benzodiazepines (midazolam 1 to 2mg IV or diazepam 5 to 10 mg IV, rapid escalation in dosing)
Hypertension
IV benzodiazepines,  phentolamine, nitroprusside, nitroglycerin,, or nicardipine
Seizures
IV benzodiazepines, followed by propofol if needed
Ventricular dysrhythmias
IV benzodiazepines, followed by hypertonic sodium bicarbonate if wide QRS
Obstruction or perforation
OR for immediate ex-lap, then advanced imaging study to document a clear GI tract
Endoscopic removal highly controversial, risk of packet perforation
Expectant management, no surgery, close monitoring in ICU until passage of all packets
Whole bowel irrigation with polyethylene glycol via NGT at 2L per hour
Activated charcoal more useful in<unk>  stuffers
Naloxone: may require very high doses
2 to 5mg IV initially, repeat 2mg q5min until responsive
then total amount required for response should be given every hour as continuous drip
2 to 5mg IV initially, repeat 2mg q5min until responsive
then total amount required for response should be given every hour as continuous drip
Immediate OR for surgical decontamination
No place for conservative management
Pharmacologic stabilization appropriate but not definitive, do not delay transfer to the OR
Hyperthermia
Active external cooling
IV benzodiazepines (midazolam 1 to 2mg IV or diazepam 5 to 10 mg IV, rapid escalation in dosing)
Hypertension
IV benzodiazepines,  phentolamine, nitroprusside, nitroglycerin,, or nicardipine
Seizures
IV benzodiazepines, followed by propofol if needed
Ventricular dysrhythmias
IV benzodiazepines, followed by hypertonic sodium bicarbonate if wide QRS
Hyperthermia
Active external cooling
IV benzodiazepines (midazolam 1 to 2mg IV or diazepam 5 to 10 mg IV, rapid escalation in dosing)
Hypertension
IV benzodiazepines,  phentolamine, nitroprusside, nitroglycerin,, or nicardipine
Seizures
IV benzodiazepines, followed by propofol if needed
Ventricular dysrhythmias
IV benzodiazepines, followed by hypertonic sodium bicarbonate if wide QRS
Active external cooling
IV benzodiazepines (midazolam 1 to 2mg IV or diazepam 5 to 10 mg IV, rapid escalation in dosing)
IV benzodiazepines,  phentolamine, nitroprusside, nitroglycerin,, or nicardipine
IV benzodiazepines, followed by propofol if needed
IV benzodiazepines, followed by hypertonic sodium bicarbonate if wide QRS
OR for immediate ex-lap, then advanced imaging study to document a clear GI tract
Endoscopic removal highly controversial, risk of packet perforation
Body packing
25C-NBOMe‎
Hematoma block
Alcohol
Procedural sedation
Amphetamines
Procedural sedation 
Bath salts