BurnedFingertipA patient presents to your Emergency Department with altered mental status and somnolence. You don’t smell alcohol on breath and you don’t see needle track marks. What clinical clue points you towards cocaine or methamphetamine ingestion?

Trick of the trade

Look for burned fingertips!

Patients who smoke crack or methamphetamines typically use a glass pipe as shown below. The glass pipes get hot and often burn the tips of people’s fingers.

Crack pipe


Meth pipe


After a crack or methampethamine binge, patients often get a washed-out syndrome where their catecholamine stores are completely depleted. They sleep for hours. Often they come in this washed-out stage when they present to the ED.

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at https://t.co/50EapJORCa Bio: https://t.co/7v7cgJqNEn
Michelle Lin, MD