SFGH am report pearls 2.16 – Molly abuse and C1 fractures

– Molly is a form of MDMA that is touted to be more “pure” than other forms such as ecstasy

– MDMA is a sympathomemetic amphetamine that causes release of catecholamines (norepi and dopamine) and blocks their reuptake.  It is structurally similar to serotonin and also causes increased serotonin release and reuptake inhibition.


reviving the favorite NMS vs serotonin syndrome graph from Michelle Yu, our pulm/ICU fellow:



– treatment of serotonin syndrome:

– hold serotonergic agents

– supportive care: (cooling, fluids)

– sedate with benzodiazepines, consider paralysis

– consider serotonin antagonists: cycloheptadine (histamine-1 receptor antagonist with nonspecific 5-HT1A and 5-HT2A antagonist properties)


From the spinal shock case:


– neurogenic shock is a distributive shock secondary to reduced vascular tone and PVR because of loss of sympathetic input and classically leads to bradycardia and hypotension

– bradycardia usually occurs in severe, high cervical (C1-C5) lesions – treat with external pacing or administration of atropine


Graudins A, Stearman A, Chan B. Treatment of the serotonin syndrome with cyproheptadine. J Emerg Med 1998; 16:615.

Kalant H. The pharmacology and toxicology of “ecstasy” (MDMA) and related drugs. CMAJ 2001; 165:917.

Summers, RL et al. Characterization of the spectrum of hemodynamic profiles in trauma patients with acute neurogenic shock. J Crit Care. 2013 Aug;28(4);531.


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