Transcript Maximizing Heart Failure Care

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 latenight rave
 Sudden loss of
consciousness
while standing
 Fall
 Unresponsive
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 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?
 Scene
Survey
 ABCs
 O2
 IV
 History
 Physical
Exam
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?
 Infection
 Toxic
 Metabolic
 Hypoxemia
 Neurologic
 Psychiatric
What happened to our patient?
• Rave party
• Returned home
6:30 AM
• Drinking
• Smoking
• GHB
Clinical Features of GHB
• Euphoria, intoxication,
aphrodisiac
• Respiratory depression
• Aggression, delirium,
coma
• Pinpoint pupils
• Vomiting (50%)
• Seizures
• Bradycardia
• Myoclonic jerking
movements
Street Names for GHB
GHB
Greivous Body Harm
GBH
Georgia home boy
Gib
Natural sleep-500
Gamma-OH
Gamma hydrate
Liquid X
Organic Quallude
Liquid E
Liquid ecstasy
Liquid G
Somatomax
Soap
Salty water
Scoop
Sodium oxybate
Easy lay
Cherry menth
Fantasy
G-Riffick
Treatment for Altered Mental Status
• ABCs
• Complete vitals
(temperature)
• Cervical spine
precautions
• Scene Survey
• Continuous monitoring
• Transport
• Keep patient safe
Pearls of Wisdom
GHB
• Patients may be
comatose and may
become suddenly
alert and oriented.
• Intubated patients
need to be wellsecured.
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
• Smoked, injected, or
swallowed
• Initial rush, severe
agitation, violent and
dangerous behavior
• Stay awake for days
• Scene safety is very
important
Ketamine
• Special K, K, Vitamin K,
Fort Dodge
• Inhaled, injected, orally,
smoked
• Increases blood
pressure, heart rate,
muscle tone, salivaton
• Brain-body dissociation
Rohypnol
• Roofies, roaches,
ropies
• Fast-acting
benzodiazepine
• Initial “date-rape
drug”
Significant
sedation
Amnesia
LSD
• Acid
• Potent psychactive
agent
• “Blotter paper”
• “LSD Trip”
• Increased sympathetic
response
 Dilated pupils
 Elevations in BP, pulse,
temp
 Seizure
 Coma
PCP
• Angel dust
• Hallucinogen
• CNS stimulation or
depression
Violent (35%)
Agitated (34%)
Bizarre behavior
(29%)
Hypoglycemia
(22%)
• SCENE SAFETY!!
Club Drugs
Summary
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Scene Safety
Airway
Be aware for sudden changes
Continuosly monitor
Be thorough
 Scene survey
 History
 Physical Exam
 Talk to Bystanders
Questions??