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Club Drugs The Prehospital Perspective

Club Drugs The Prehospital Perspective

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Club Drugs The Prehospital Perspective

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  1. Club DrugsThe Prehospital Perspective Steven Katz, M.D., FACEP, EMT-P Associate Medical Director Palm Beach County Fire Rescue President National Paramedic Institute

  2. EMS Case Study HPI • 18 year-old girl returns from late-night rave • Sudden loss of consciousness while standing • Fall • Unresponsive

  3. EMS Case Study Past Medical History:Unknown Medications:Unknown Allergies:None Social History:smokes when she’s drinking, alcohol on the weekends, no drugs

  4. 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

  5. EMS Case StudyYour immediate treatment? • Scene Survey • ABCs • O2 • IV • History • Physical Exam

  6. 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

  7. EMS Case StudyWhat may have happened? • Infection • Toxic • Metabolic • Hypoxemia • Neurologic • Psychiatric

  8. Rave party Returned home 6:30 AM Drinking Smoking GHB What happened to our patient?

  9. Clinical Features of GHB • Euphoria, intoxication, aphrodisiac • Respiratory depression • Aggression, delirium, coma • Pinpoint pupils • Vomiting (50%) • Seizures • Bradycardia • Myoclonic jerking movements

  10. Street Names for GHB

  11. Treatment for Altered Mental Status • ABCs • Complete vitals (temperature) • Cervical spine precautions • Scene Survey • Continuous monitoring • Transport • Keep patient safe

  12. Pearls of WisdomGHB • Patients may be comatose and may become suddenly alert and oriented. • Intubated patients need to be well-secured.

  13. 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

  14. Methamphetamine • Smoked, injected, or swallowed • Initial rush, severe agitation, violent and dangerous behavior • Stay awake for days • Scene safety is very important

  15. Ketamine • Special K, K, Vitamin K, Fort Dodge • Inhaled, injected, orally, smoked • Increases blood pressure, heart rate, muscle tone, salivaton • Brain-body dissociation

  16. Rohypnol • Roofies, roaches, ropies • Fast-acting benzodiazepine • Initial “date-rape drug” • Significant sedation • Amnesia

  17. LSD • Acid • Potent psychactive agent • “Blotter paper” • “LSD Trip” • Increased sympathetic response • Dilated pupils • Elevations in BP, pulse, temp • Seizure • Coma

  18. PCP • Angel dust • Hallucinogen • CNS stimulation or depression • Violent (35%) • Agitated (34%) • Bizarre behavior (29%) • Hypoglycemia (22%) • SCENE SAFETY!!

  19. Club DrugsSummary • Scene Safety • Airway • Be aware for sudden changes • Continuosly monitor • Be thorough • Scene survey • History • Physical Exam • Talk to Bystanders

  20. Questions??