cocaine toxicity clinical management signs symptoms authoritative guideline

cocaine toxicity

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An educational one-page medical poster about cocaine toxicity, with a cocaine leaf and chemical powder visual, emergency warning symbols, and clear empty content panels for headings and bullet points.

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mkdir -p "/tmp/workspace/cocaine-poster/src" "/tmp/workspace/cocaine-poster/output" && python - <<'PY' from PIL import Image, ImageDraw, ImageFont from textwrap import wrap W,H=2480,3508 im=Image.new('RGB',(W,H),'#f7f1e7') d=ImageDraw.Draw(im) # Font paths reg='/usr/share/fonts/truetype/dejavu/DejaVuSans.ttf' bold='/usr/share/fonts/truetype/dejavu/DejaVuSans-Bold.ttf' serif='/usr/share/fonts/truetype/dejavu/DejaVuSerif.ttf' F=lambda p,s: ImageFont.truetype(p,s) def rounded(box,fill,outline=None,r=24,width=3): d.rounded_rectangle(box,r,fill=fill,outline=outline,width=width) def text(x,y,s,font,fill='#213039',anchor=None): d.text((x,y),s,font=font,fill=fill,anchor=anchor) def line_text(x,y,content,font,maxw,fill='#2b363a',lead=None, bullet=False): # word wrapper based on pixel length words=content.split(); lines=[]; cur='' for word in words: trial=(cur+' '+word).strip() if d.textlength(trial,font=font)<=maxw: cur=trial else: if cur: lines.append(cur) cur=word if cur: lines.append(cur) lh=lead or int(font.size*1.30) for i,l in enumerate(lines): xx=x if bullet and i==0: text(x,y+i*lh,'•',font,'#a94c43') xx=x+26 elif bullet: xx=x+26 text(xx,y+i*lh,l,font,fill) return y+lh*len(lines) def section(box,title,items,accent='#a94c43',cols=1, note=False): x1,y1,x2,y2=box rounded(box,'#fffdf9','#d5c8bb',20,3) d.rounded_rectangle((x1,y1,x2,y1+54),20,fill=accent) d.rectangle((x1,y1+30,x2,y1+54),fill=accent) text(x1+26,y1+9,title.upper(),F(bold,27),'white') pad=25; top=y1+72 if cols==1: y=top for item in items: if isinstance(item,tuple): head, body=item text(x1+pad,y,head,F(bold,23),'#263940'); y+=32 y=line_text(x1+pad,y,body,F(reg,21),x2-x1-2*pad,lead=28,bullet=True)+8 else: y=line_text(x1+pad,y,item,F(reg,21),x2-x1-2*pad,lead=28,bullet=True)+7 else: gap=18; cw=(x2-x1-2*pad-gap)//2 for ci,arr in enumerate(items): cx=x1+pad+ci*(cw+gap); y=top for item in arr: if isinstance(item,tuple): head,body=item; text(cx,y,head,F(bold,22),'#263940'); y+=30 y=line_text(cx,y,body,F(reg,20),cw,lead=26,bullet=True)+7 else: y=line_text(cx,y,item,F(reg,20),cw,lead=26,bullet=True)+7 # Header # thin top band d.rectangle((0,0,W,70),fill='#263940') text(W//2,35,'FORENSIC TOXICOLOGY • RAPID REVIEW',F(bold,25),'#f5ddae',anchor='mm') text(130,120,'DELIRIANTS',F(bold,37),'#a94c43') text(130,176,'COCAINE',F(bold,95),'#263940') text(130,282,'A one-page study poster: acute toxicity, chronic use, and medicolegal points',F(reg,27),'#556066') # decorative circle D=(2060,104,2315,359); d.ellipse(D,fill='#a94c43'); text(2187,198,'51',F(bold,68),'white',anchor='mm'); text(2187,270,'CHAPTER',F(bold,20),'white',anchor='mm') d.line((130,337,2350,337),fill='#a94c43',width=5) # grids coordinates section((130,375,2350,630),'Learning Objectives',[ [ ('Must know','Signs, symptoms and treatment of cocaine toxicity; medico-legal aspects; Magnan’s syndrome.'), ], [ ('Desirable to know','Cocaine washed-out syndrome; cocainomania; crack lung.'), ]],cols=2) section((130,662,1180,1180),'Introduction',[ ('Source','Colourless, odourless crystalline alkaloid from Erythroxylum coca leaves; soluble in water, freely soluble in alcohol.'), ('Preparations','Hydrochloride salt and alkaloid base (freebase or crack). A frequent cause of drug-related emergency visits.'), ('Common names','Crack, pasta, bazooka, snuff, coke, snow or white lady.')]) section((1210,662,2350,1180),'Action • Absorption and Excretion • Routes of Intake',[ ('Action','Increases synaptic dopamine, norepinephrine and serotonin; local anaesthetic activity via sodium-channel blockade; brief cortical stimulation followed by depression.'), ('Absorption and excretion','Rapid mucosal and subcutaneous absorption. Hepatic and plasma metabolism; a small amount is excreted unchanged in urine. Cocaethylene may occur with alcohol co-use.'), ('Routes of intake','Chewing, nasal application or snorting, smoking/freebasing, IV injection, inhalation, or ingestion.')]) section((130,1212,2350,1790),'Signs and Symptoms',[ [ ('I. Stage of excitement','Rapid onset after inhalation/IV use. Hypertension, tachycardia, hyperthermia and mydriasis. Euphoria, talkativeness, restlessness, anxiety, tremor, hallucinations and seizures may occur. GI: bitter taste, dry mouth, vomiting/diarrhoea. Respiratory: tachypnoea, dyspnoea, cyanosis.'), ], [ ('II. Stage of depression','Later: slow respiration, profuse sweating, calm/dull state. Severe toxicity: coma, areflexia, fixed dilated pupils, loss of vital support; ventricular dysrhythmias, hypotension, pulmonary oedema, respiratory failure.'), ]],cols=2) section((130,1822,1180,2350),'Severity • Diagnosis',[ ('Cause of death','Rapid progression can lead to convulsions and death from respiratory failure, cerebral haemorrhage or cardiac failure. Tea-coloured urine may signal rhabdomyolysis and renal injury.'), ('Fatal dose','Approx. 20 mg IV; 500 mg to 1.2 g orally.'), ('Fatal period','Few minutes to 1-2 hours.'), ('Differential diagnosis','Lithium toxicity, cyclic antidepressant toxicity, neuroleptic malignant syndrome, sedative/alcohol withdrawal, thyroid storm and other hyperadrenergic states.'), ('Diagnosis','Clinical diagnosis supported by qualitative toxicology of blood/urine. Urine cocaine metabolites support exposure but do not establish clinical toxicity.')]) section((1210,1822,2350,2350),'Treatment',[ ('Principle','No specific antidote. Treat symptoms until acute effects resolve; protect airway, support breathing and circulation.'), ('Decontamination','For oral ingestion: consider gastric lavage where appropriate and activated charcoal.'), ('Control seizures/agitation','Benzodiazepines are first-line. Avoid physical restraint when possible because of rhabdomyolysis and hyperthermia risk.'), ('Cardiovascular care','Treat dysrhythmias according to ACLS. Short-acting vasodilators and beta-blockers may be used for tachycardia/hypertension according to protocol.'), ('Support','Thiamine 100 mg IV; maintain airway, give artificial respiration and inhalation support as needed.')]) section((130,2382,1180,2985),'Complications • Postmortem Findings',[ ('Complications','CNS: stroke, subarachnoid/intracerebral haemorrhage. CVS: myocardial ischaemia/infarction, arrhythmias and aortic dissection. Pulmonary: infarcts, eosinophilia with granuloma, cough, haemoptysis, reactive airway disease, pneumonitis (crack lung), barotrauma/pneumothorax.'), ('Postmortem findings','Usually non-specific. Linear excoriations or “crack-pipe” burns; track marks at usual or unusual sites. Intense asphyxial signs and cardiac dilatation may occur. Preserve blood with fluoride.')]) section((1210,2382,2350,2985),'Medico-legal Aspects • Nota Bene',[ ('Medico-legal aspects','Accidental exposure may occur through urethral, vaginal or rectal insertion, body packing/stuffing. Cocaine is rarely used for homicide or suicide; deliberate poisoning of pregnant women, infants or children has been reported. May increase libido and impair moral judgement; destroyed cocaine is difficult to detect chemically.'), ('Nota bene: tests','Mandelin test: cocaine gives orange colour. Scott test: cobalt thiocyanate produces blue precipitate if cocaine is present.'), ('Nota bene: crack','Crack is freebase cocaine made by removing hydrochloride. “Crack lung” can occur 24-48 h after use with chest pain, cough, haemoptysis, dyspnoea, bronchospasm and diffuse infiltrates. “Crack dancing” describes extrapyramidal movement disorders.')]) section((130,3017,2350,3410),'Cocainism (Cocainomania/Cocainophagia) • Signs and Symptoms • Magnan’s Syndrome/Cocaine Bugs',[ ('Cocainism (cocainomania/cocainophagia)','Irresistible craving to intoxicate with cocaine or its salts. Repeated dosing to maintain a high and avoid a crash; tolerance may reach 10 g/day.'), ('Signs and symptoms','Emaciation, anorexia, GI disturbance, loss of libido, erectile dysfunction, gynaecomastia/galactorrhoea, menstrual disturbance and infertility. Pale face, glazed sunken eyes, dilated pupils, black teeth/ulcerated septum; CNS degeneration with hallucinations, convulsions and delirium.'), ('Magnan’s syndrome/cocaine bugs','Often in cocaine users, particularly IV users. Tactile hallucination of grains of sand or insects crawling under the skin, causing itching (formication).')]) # Footer d.rectangle((0,3440,W,H),fill='#263940') text(W//2,3474,'EDUCATIONAL REVISION AID • IN SUSPECTED POISONING, SEEK URGENT EMERGENCY CARE',F(bold,20),'#f5ddae',anchor='mm') # save out='/tmp/workspace/cocaine-poster/output/Cocaine_One_Page_Study_Poster.png' im.save(out,dpi=(300,300),compress_level=6) print(out) PY file "/tmp/workspace/cocaine-poster/output/Cocaine_One_Page_Study_Poster.png" && ls -lh "/tmp/workspace/cocaine-poster/output/Cocaine_One_Page_Study_Poster.png"

fc-match -f '%{file}\n' 'DejaVu Sans' && fc-match -f '%{file}\n' 'DejaVu Serif'

python - <<'PY' from PIL import Image,ImageDraw,ImageFont W,H=2480,3508; im=Image.new('RGB',(W,H),'#f8f4eb');d=ImageDraw.Draw(im) R='/usr/share/fonts/google-noto-vf/NotoSans[wght].ttf'; B=R F=lambda s:ImageFont.truetype(R,s) def tx(x,y,t,s=24,c='#263940'): d.text((x,y),t,font=F(s),fill=c) def wrap(t,font,w): a=[];q='' for z in t.split(): u=(q+' '+z).strip() if d.textlength(u,font=font)<=w:q=u else:a.append(q);q=z if q:a.append(q) return a def box(x,y,w,h,title,body): d.rounded_rectangle((x,y,x+w,y+h),22,fill='#fffdf9',outline='#d6c7b7',width=3);d.rounded_rectangle((x,y,x+w,y+50),22,fill='#a64d43');d.rectangle((x,y+28,x+w,y+50),fill='#a64d43');tx(x+22,y+8,title.upper(),25,'white'); yy=y+68 for para in body: if '|' in para: h,b=para.split('|',1);tx(x+20,yy,h,21,'#a64d43');yy+=28 else:b=para for i,line in enumerate(wrap(b,F(19),w-44)): tx(x+20,yy,'• '*(i==0)+line,19);yy+=25 yy+=5 # header d.rectangle((0,0,W,72),fill='#263940');tx(775,22,'FORENSIC TOXICOLOGY • RAPID REVIEW',24,'#f5dda9');tx(130,115,'DELIRIANTS',36,'#a64d43');tx(130,167,'COCAINE',92);tx(130,280,'One-page study poster: acute toxicity, chronic use and medicolegal points',26,'#5e666a');d.ellipse((2060,105,2320,365),fill='#a64d43');tx(2142,170,'51',66,'white');tx(2095,260,'CHAPTER',21,'white');d.line((130,337,2350,337),fill='#a64d43',width=5) box(130,375,2220,230,'Learning Objectives',["Must know|Signs, symptoms and treatment of cocaine toxicity; medico-legal aspects; Magnan’s syndrome.","Desirable to know|Cocaine washed-out syndrome; cocainomania; crack lung."]) box(130,635,1050,500,'Introduction',["Source|Colourless, odourless crystalline alkaloid from Erythroxylum coca leaves; soluble in water and alcohol.","Preparations|Hydrochloride salt and alkaloid base (freebase or crack); frequent cause of drug-related ED visits.","Common names|Crack, pasta, bazooka, snuff, coke, snow, white lady."]) box(1210,635,1140,500,'Action • Absorption & Excretion • Routes of Intake',["Action|Increases synaptic dopamine, norepinephrine and serotonin. Local anaesthetic sodium-channel blockade. Brief stimulation then depression.","Absorption and excretion|Rapid mucosal/subcutaneous absorption; metabolism is mainly hepatic and plasma. Cocaethylene may occur with alcohol co-use.","Routes of intake|Chewing, nasal application/snorting, smoking/freebasing, IV injection, inhalation or ingestion."]) box(130,1165,2220,515,'Signs and Symptoms',["I. Stage of excitement|Rapid onset. Hypertension, tachycardia, hyperthermia, mydriasis; euphoria, anxiety, tremor, hallucinations and seizures. Bitter taste, dry mouth, vomiting/diarrhoea; tachypnoea, dyspnoea and cyanosis.","II. Stage of depression|Slow respiration, sweating, dullness. Severe toxicity: coma, areflexia, fixed dilated pupils, dysrhythmias, hypotension, pulmonary oedema and respiratory failure."]) box(130,1710,1050,550,'Severity • Diagnosis',["Cause of death|Rapid convulsions with respiratory failure, cerebral haemorrhage or cardiac failure. Tea-coloured urine suggests rhabdomyolysis and renal injury.","Fatal dose|Approx. 20 mg IV; 500 mg to 1.2 g orally.","Fatal period|Few minutes to 1-2 hours.","Differential diagnosis|Lithium and cyclic antidepressant toxicity, neuroleptic malignant syndrome, alcohol/sedative withdrawal, thyroid storm and other hyperadrenergic states.","Diagnosis|Clinical diagnosis plus toxicology of blood/urine. Urine metabolites support exposure but do not establish clinical toxicity."]) box(1210,1710,1140,550,'Treatment',["Principle|No specific antidote. Symptomatic treatment with airway, breathing and circulation support.","Decontamination|For oral ingestion, gastric lavage where appropriate and activated charcoal.","Seizures/agitation|Benzodiazepines first-line. Avoid physical restraint where possible due to hyperthermia/rhabdomyolysis risk.","Cardiovascular care|Treat dysrhythmias by ACLS. Use short-acting vasodilators/beta-blockers for tachycardia or hypertension according to protocol.","Support|Thiamine 100 mg IV; protect airway and provide ventilation/inhalation support as required."]) box(130,2290,1050,570,'Complications • Postmortem Findings',["Complications|CNS: stroke, subarachnoid/intracerebral haemorrhage. CVS: myocardial ischaemia/infarction, arrhythmias, aortic dissection. Pulmonary: infarcts, eosinophilia/granuloma, crack lung, barotrauma/pneumothorax.","Postmortem findings|Non-specific. Linear excoriations or crack-pipe burns; track marks; intense asphyxial signs and cardiac dilatation. Preserve blood with fluoride."]) box(1210,2290,1140,570,'Medico-legal Aspects • Nota Bene',["Medico-legal aspects|Accidental exposure through body packing/stuffing or urethral, vaginal and rectal insertion. Rarely homicide or suicide. May increase libido and impair moral judgement.","Nota bene: tests|Mandelin test: orange colour. Scott test: cobalt thiocyanate gives blue precipitate.","Nota bene: crack|Freebase cocaine. Crack lung may occur 24-48 h after use: chest pain, cough, haemoptysis, dyspnoea, bronchospasm and diffuse infiltrates. Crack dancing = extrapyramidal movements."]) box(130,2890,2220,500,'Cocainism (Cocainomania/Cocainophagia) • Signs and Symptoms • Magnan’s Syndrome/Cocaine Bugs',["Cocainism (cocainomania/cocainophagia)|Irresistible craving. Repeated doses maintain the high and prevent crash; tolerance may reach 10 g/day.","Signs and symptoms|Emaciation, anorexia, GI disturbance, sexual dysfunction, gynaecomastia/galactorrhoea, menstrual problems and infertility; pale face, glazed eyes, dilated pupils, black teeth, septal ulceration, hallucinations, convulsions and delirium.","Magnan’s syndrome/cocaine bugs|Tactile hallucination of sand or insects crawling under skin, producing itching (formication), especially in IV users."]) d.rectangle((0,3438,W,H),fill='#263940');tx(445,3463,'EDUCATIONAL REVISION AID • SUSPECTED POISONING REQUIRES URGENT EMERGENCY CARE',19,'#f5dda9') out='/tmp/workspace/cocaine-poster/output/Cocaine_One_Page_Study_Poster.png';im.save(out,dpi=(300,300));print(out) PY file "/tmp/workspace/cocaine-poster/output/Cocaine_One_Page_Study_Poster.png" && ls -lh "/tmp/workspace/cocaine-poster/output/Cocaine_One_Page_Study_Poster.png"

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python - <<'PY' from PIL import Image src='/tmp/workspace/cocaine-poster/output/Cocaine_One_Page_Study_Poster.png' out='/tmp/workspace/cocaine-poster/output/Cocaine_One_Page_Study_Poster.pdf' im=Image.open(src).convert('RGB') im.save(out, 'PDF', resolution=300.0, title='Cocaine One-Page Study Poster', author='Orris') print(out) PY python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/cocaine-poster/output/Cocaine_One_Page_Study_Poster.pdf' r=PdfReader(p) print('pages:',len(r.pages)) print('size:',r.pages[0].mediabox) PY ls -lh "/tmp/workspace/cocaine-poster/output/Cocaine_One_Page_Study_Poster.pdf"