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Traumatic brain injury after a motor vehicle accident: Fact or “fantasy”?
  1. D G E Caldicott,
  2. N Edwards
  1. Royal Adelaide Hospital, South Australia
  1. Dr Caldicott, Department of Emergency Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia (dcaldico{at}mail.rah.sa.gov.au)

https://doi.org/10.1136/emj.18.6.458

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    Gamma hydroxybutyrate (GHB) is a water soluble, naturally occurring, tetra-carbon molecule. It has intermittently found use as a hypnotic anaesthetic agent, in treatment for narcolepsy, as an anabolic agent, and more recently as a drug of abuse1–7 (also known as “fantasy”, “GBH”, etc (see box 1 ). Review of the literature refutes the suggestion that GHB is a safe “natural high”, with a number of fatalities from overdose now reported.8,9 Deaths occur from profound respiratory and cardiovascular depression.7–9 We report two cases of Fantasy overdose in association with a motor vehicle crash, the presenting symptoms of which prompted treating doctors to erroneously suspect serious intracranial pathology.

    Box 1 Street synonyms for gamma hydroxybutyrate

    Fantasy

    Phantasy

    Liquid ecstasy

    Liquid gold

    Liquid X

    Cherry Meth

    Soap

    GBH

    Case report

    A 21 year old man and 20 year old woman were brought to the Trauma Unit of the Royal Adelaide Hospital after a motor vehicle crash.

    The man was the restrained driver of a vehicle that had lost control and crashed into a stobie pole (see fig 1), at a speed in excess of 60 kph. There was at least 60 cm intrusion into the front passenger compartment. His GCS was estimated as 14 (E=4, V=4, M=6) at the scene, where he was aggressive and combative, bleeding from a 5 cm midline laceration to his forehead. On arrival, he remained uncooperative, and required restraint. Further examination showed abrasions to his right shoulder, with an …

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    Footnotes

    • Funding: none.

    • Conflicts of interest: none.