Transcript AEMT Transition - Unit 27

TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
27
Toxicology: Street Drugs
Objectives
• Discuss the frequency of abused drugs
in the U.S.
• Recognize how to recognize street
drugs by assessment patterns.
• Discuss assessment findings and
management for a patient suffering
from a street drug overdose.
Introduction
• Drug use was, at one time, almost
exclusive to large metro areas.
• Drug use is now seen in rural areas and
in all socioeconomic classes.
• Mixing of illegal drugs has also gained
popularity.
Epidemiology
• The National Survey on Drug Use and
Health (NSDUH) reports over 19.9
million Americans ages 12 and older
used illegal drugs within the month of
survey in 2007.
• Highest bracket—18-20 year olds.
Epidemiology (cont’d)
• Most commonly abused drugs in
descending order: marijuana,
psychotropics, cocaine, hallucinogens,
inhalants, and heroin.
Pathophysiology (cont’d)
• Too many drugs and drug names to
possibly know them all.
Pathophysiology (cont’d)
• Learn to recognize a “toxidrome,”
which refers to how the drug is
affecting the body.
– Uppers
– Downers
– Narcotics
– Mind-altering
– Volatile chemicals
Commonly Abused Drugs
Pathophysiology (cont’d)
• Stimulants
– Profound effect on body that imitates
the sympathetic nervous system.
– HTN, tachycardia, pupil dilation, temp
elevation, trembling.
– Patient may experience a hypertensive
crisis, an MI, or even seizures.
– Patient may also be combative,
aggressive, or delirious.
Pathophysiology (cont’d)
• Depressants (narcotics and sedatives)
– Lowering of bodily activities.
– Brain stem depression.
– HR drops, blood pressure drops,
respirations drop.
– Orientation diminishes, muscle tone
goes lax.
– Pupillary constriction common.
Pathophysiology (cont’d)
• Cannabis products
– Both psychological and physiological
effects.
– Changes in perception.
– Mood swings.
– Disturbed short-term memory.
– Heart rate elevates, B/P drops.
Pathophysiology (cont’d)
• Hallucinogens
– Agents that change perceptions of
reality.
– Patient “hears” and “sees” things that
are not part of reality.
– Distortions to shapes, colors, sounds.
– Hemodynamically they are usually
stable, but mentally they have
disturbances.
Pathophysiology (cont’d)
• Inhalants
– Volatile in nature, they are sniffed or
inhaled.
– Many agents are found in home
products.
– Damage may also occur to mucous
membranes and lung tissue.
Pathophysiology (cont’d)
• Inhalants
– Many of these agents displace oxygen
and the patient has confusion, coma,
seizures, heart failure, or even
pulmonary edema.
Pathophysiology (cont’d)
• Alcohol
– Brain is the first organ affected with
ingestion.
– Initial feeling of euphoria with
subsequent depression and impairment
of cognition and other abilities.
– Great risk for vomiting and aspiration.
Assessment Findings
• General considerations
– Use dispatch information.
– Always protect yourself from harm.
– Clues at the scene may point to drug
abuse.
– Learn to recognize not the drug itself,
but what toxidrome it fits into.
A variety of substances may be abused.
Emergency Medical Care
• Ensure an open airway.
• Provide supplemental oxygen.
• Position the patient (consider blood
pressure and potential for aspiration).
• Determine blood glucose level.
Emergency Medical Care (cont’d)
• Consider use of 1g/kg activated
charcoal if situation is appropriate.
• If narcotic (opioid) overdose is
suspected, administer naloxone 0.4-2.0
mg titrated to respiratory effort.
• Provide rapid transport to ED.
Case Study
• You are called to a party where several
underage teenagers were reportedly
drinking and doing drugs (per neighbor
who summoned PD and EMS). Upon
your arrival, a patient is found
unresponsive on the porch with
gurgling respirations that are slow. PD
is already on the scene.
Case Study (cont’d)
• Scene Size-Up
– Standard precautions taken.
– 16–17-year-old male, normal weight.
– No sign of struggle or trauma.
– Patient lying supine, looks
unresponsive.
– NOI is “unknown medical.”
– PD on scene, no additional resources
needed.
Case Study (cont’d)
• Primary Assessment Findings
– Patient unconscious to noxious stimuli.
– Gurgling sounds coming from airway.
– Breathing is slow and shallow.
– Carotid pulse feels slow, peripheral
pulse absent.
– No signs of bleeding or trauma.
– No one on scene seems to “know” this
person.
Case Study (cont’d)
• Is this patient a high or low priority?
• What life threats, if any, is this patient
presenting with?
• What interventions are warranted at
this time?
Case Study (cont’d)
• Medical History
– Unknown
• Medications
– Unknown
• Allergies
– Unknown
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings
– Patient unresponsive to noxious stimuli.
– Airway now clear, breathing slow at
6/min.
– No alveolar breath sounds, no
peripheral pulse.
– Pulse oximeter reads 88% on room air.
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings
– Skin cool, dry, ashen in color.
– B/P unobtainable, HR 122/min, RR
6/min.
– Pupils pinpoint and nonreactive.
Case Study (cont’d)
• What would be your differentials with
this type of overdose?
• What is your final differential for the
type of toxidrome?
• Relate the vital signs to the category of
toxidrome.
Case Study (cont’d)
• Care provided:
– Spinal immobilization as a precaution.
– High-flow oxygen via PPV @ 10/min.
– Ongoing pulse oximeter reading and
BGL testing.
– Supine positioning.
– Narcan administration
Summary
• Drug abuse is still on the rise in many
regions and profiles of individuals in the
U.S.
• So many drugs are now abused, the
Advanced EMT may want to focus on
recognizing the toxidrome itself, not
the specific agent.
Summary (cont’d)
• Management must be geared toward
the toxidrome, and supportive of any
lost bodily function.