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Club Drugs The Prehospital Perspective. Steven Katz, M.D., FACEP, EMT-P Associate Medical Director Palm Beach County Fire Rescue President National Paramedic Institute. EMS Case Study. HPI 18 year-old girl returns from late-night rave Sudden loss of consciousness while standing Fall

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club drugs the prehospital perspective

Club DrugsThe Prehospital Perspective

Steven Katz, M.D., FACEP, EMT-P

Associate Medical Director

Palm Beach County Fire Rescue

President

National Paramedic Institute

ems case study
EMS Case Study

HPI

  • 18 year-old girl returns from late-night rave
  • Sudden loss of consciousness while standing
  • Fall
  • Unresponsive
ems case study3
EMS Case Study

Past Medical History:Unknown

Medications:Unknown

Allergies:None

Social History:smokes when she’s drinking, alcohol on the weekends, no drugs

ems case study4
EMS Case Study

Vitals

  • Temp 98.8
  • BP 110/70
  • Resp 4 (agonal)
  • Pulse 110 (regular)
  • O2sat 70% on room air

EKG

  • Sinus tachycardia 110
  • No ischemic changes
  • No ectopy
ems case study your immediate treatment
EMS Case StudyYour immediate treatment?
  • Scene Survey
  • ABCs
  • O2
  • IV
  • History
  • Physical Exam
ems case study6
EMS Case Study

Physical Exam

General: unresponsive, flaccid, lying in pool of vomit

HEENT: unremarkable, no evidence of trauma

Lungs: agonal respirations

Cardiac: tachycardic, regular

Abdomen: soft, no apparent tenderness

Back: unremarkable

Extremities: no evidence of trauma, no pedal edema

Skin: dry, covered in vomit

Neuro: unresponsive, nonverbal

ems case study what may have happened
EMS Case StudyWhat may have happened?
  • Infection
  • Toxic
  • Metabolic
  • Hypoxemia
  • Neurologic
  • Psychiatric
what happened to our patient
Rave party

Returned home 6:30 AM

Drinking

Smoking

GHB

What happened to our patient?
clinical features of ghb
Clinical Features of GHB
  • Euphoria, intoxication, aphrodisiac
  • Respiratory depression
  • Aggression, delirium, coma
  • Pinpoint pupils
  • Vomiting (50%)
  • Seizures
  • Bradycardia
  • Myoclonic jerking movements
treatment for altered mental status
Treatment for Altered Mental Status
  • ABCs
  • Complete vitals (temperature)
  • Cervical spine precautions
  • Scene Survey
  • Continuous monitoring
  • Transport
  • Keep patient safe
pearls of wisdom ghb
Pearls of WisdomGHB
  • Patients may be comatose and may become suddenly alert and oriented.
  • Intubated patients need to be well-secured.
ecstasy
Ecstasy
  • Popular club drug
  • Alterations in colors or sensations of textures, heightened sexual interest
  • Stimulant
    • Hallucinations
    • Decreased appetite
    • Increased heart rate and blood pressure, increased body temperature
    • Teeth grinding
    • Dilated pupils
    • Panic attacks
methamphetamine
Methamphetamine
  • Smoked, injected, or swallowed
  • Initial rush, severe agitation, violent and dangerous behavior
  • Stay awake for days
  • Scene safety is very important
ketamine
Ketamine
  • Special K, K, Vitamin K, Fort Dodge
  • Inhaled, injected, orally, smoked
  • Increases blood pressure, heart rate, muscle tone, salivaton
  • Brain-body dissociation
rohypnol
Rohypnol
  • Roofies, roaches, ropies
  • Fast-acting benzodiazepine
  • Initial “date-rape drug”
    • Significant sedation
    • Amnesia
slide17
LSD
  • Acid
  • Potent psychactive agent
  • “Blotter paper”
  • “LSD Trip”
  • Increased sympathetic response
    • Dilated pupils
    • Elevations in BP, pulse, temp
    • Seizure
    • Coma
slide18
PCP
  • Angel dust
  • Hallucinogen
  • CNS stimulation or depression
    • Violent (35%)
    • Agitated (34%)
    • Bizarre behavior (29%)
    • Hypoglycemia (22%)
  • SCENE SAFETY!!
club drugs summary
Club DrugsSummary
  • Scene Safety
  • Airway
  • Be aware for sudden changes
  • Continuosly monitor
  • Be thorough
    • Scene survey
    • History
    • Physical Exam
    • Talk to Bystanders
ad