Illicit Street Drugs. Objectives: Safe or Unsafe? Terminology. Scene Safety. Arielle Gonzalos, FP-C. Begins at time of dispatch with anticipation

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1 Illicit Street Drugs Objectives: Air Methods Corporation Community based services Authored by: Arielle Gonzalos, FP-C 1. Identify common street drugs with high abuse potential 2. Discuss associated signs and symptoms of an overdose. 3. Discuss scene safety, and challenges of overdose patients. 4. Utilize a case study approach for assessment of knowledge. Scene Safety Safe or Unsafe? Terminology Begins at time of dispatch with anticipation of events Observe for dangerous elements Home production of drugs (meth labs) Aggressive individuals Open needles Weapons Rush Crash Run Trip On the nod

2 DEA Classifications - no acceptable medical use I- high abuse potential with severe psychic or physical dependence liability II- less abuse potential than I and II V- less abuse potential than III Schedule V- little to no abuse potential Common Cocaine Aliases Snorted- Blow, Coke, Line, Flake, Snort, Snow Smoked- Crack, Base, Free Basing, Ice Injected- Zip Ingested/Inserted- Balling Uppers timulants are any substance that induces a ympathetic response. Illicit stimulants are ften referred to as uppers and include but are ot limited to: Cocaine Synthetic Cathinones Amphetamines Methamphetamines Ecstasy Signs and Symptoms of Cocaine Overdose Rush Hypertension Tachydysrhythmias Ischemic Heart Conditions Sudden Cardiac Arrest Stroke Seizure Nose bleed- if snorted Crash Cocaine I Acts as a stimulant by inhibiting reuptake of dopamine Derived from the coca plant leaves and may be snorted, injected, smoked, or ingested (lest common) Coke Nose

3 Synthetic Cathinone Bath Salts Developed as a substitute for cocaine and is most popular with people between the ages of 20 and 29 Created chemically and snorted, ingested, smoked, or injected (least common) Amphetamines mphetamines act as stimulants by releasing resynaptic dopamine. Prolonged use amages dopamine producing cells. Methamphetamines (Meth) 3,4-methylenedioxy (Ecstasy/MDMA) Common Aliases Bath Salts Cloud 9 Bliss Ivory Wave (blue, ivory, purple) Stardust White (dove, night, lightning) Meth I Regular meth is a pill or powder. Crystal meth resembles glass or shiny blue-white rocks. Meth is derived mainly from pseudoephedrine and may be ingested, snorted, injected or smoked (least common) Signs and Symptoms of Bath Salt Use Paranoia and violent behavior Hallucinations Delusions Seizures Hypertension Tachydysrhythmias Ischemic Heart Conditions Nausea and Vomiting Nose Bleed- if snorted Common Aliases for Meth Crank- smoked Speed- ingested Ice Crystal Glass

4 Signs and Symptoms of Meth Use Violent Behavior Insomnia Psychotic features with visual and auditory hallucinations (sensation of creeping insects is common) Tachypnea Tachydysrhythmias Hypertension Hyperthermia Stroke Ischemic Cardiac Conditions Ecstasy Has both stimulant and psychedelic effects Mainly distributed in tablet form but may be snorted, or injected Known as a party drug Faces of Meth Meth Mouth Common Aliases for Ecstasy Sings and Symptoms of Ecstasy Use Effects take 30-45min to initiate and last 4-6hrs Aggression and anxiety Increased sensitivity to touch Tachydysrhythmias Hyperthermia Ischemic Cardiac Conditions Stroke Prolonged use results in mental deficits

5 Hallucinogens he exact mechanism through which allucinogen effects are exerted is unclear. Non Organic Hallucinogens Synthetic Cannibinoids D-lysergic acid diethylamide (LSD) Phencyclidine (PCP) Organic Hallucinogens Peyote Psilocybin ( Shrooms ) Common Aliases for Synthetic Marajuana Spice K2 Gold Diamond Yucatan Fire Solar Flare K2 Summit Genie PEP Black Mamba Zombie World Non Organic Hallucinogens LSD Aliases- acid, blotter acid, dots, mellow yellow, window pain Sold as tablets, capsules, liquid, or paper and is taken orally PCP I Aliases- angel dust, embalming fluid, killer weed, rocket fuel, super grass May be smoked, injected, snorted, or taken orally Organic Hallucinogens Peyote Small, spineless cactus Aliases- buttons, cactus, mesc, peyote Smoked, chewed, drank in tea, or ingested Shrooms Available fresh or dried and have a long, slender stem topped by caps with dark gills on the underside Aliases- magic shrooms Ingested, or drank in tea Synthetic Marijuana Very different from marijuana and is made specifically to be abused Smoked Signs and Symptoms of Hallucinogens Auditory and visual hallucinations Severe agitation and anxiety Dilated pupils Hyperthermia Tachydysrhythmias Hypertension Dry Mouth Insomnia Tremors and/or seizure Nausea and Vomiting Ischemic Cardiac Conditions

6 Downers CNS depressants are substances that can slow down brain activity Illicit stimulants are often referred to as downers and include but are not limited to: Benzodiazepines Narcotics Heroin Desomorphone (Krockodil)- codeine and gasoline mix Common Aliases for Heroin Aunt Hazel Big H Black pearl Brown sugar Capital H Charley China white Dope Good horse Heroina Little boy Mud Smack Tar Benzodiazepines Overdose due to benzodiazepines most commonly ssociated with prescription medication abuse or misuse. Signs and Symptoms Alterations in mental status Respiratory depression Lethargy Hypotension Dilated pupils Heroin Opiate derived from the poppy plant Injection is the most common route however the drug can be inhaled or smoked as well Track marks of IV drug abusers Signs and Symptoms of Heroine Pin point pupils Respiratory depression Lethargy Rush followed by an n the nod response Bradycardia Hypotension Nausea and Vomiting

7 Krockodil Huffing Inhalant abuse is known as huffing The intentional of chemical vapors to achieve a high The primary population of inhalant abusers is under the age of 18 Solvents (paint thinner, gasoline, nail polish remover, glue), Aerosol sprays (spray paint) Excited Delirium (1) Excited Delirium (2) xcited delirium is a condition that is usually rug induced but can occur in non drug users s well. Signs and Symptoms: Paranoid and aggressive behavior Hyperthermia-patients often will present naked Tachycardia Tachypnea Treatment revolves around identification and management of underlying condition and management of aggression by limiting stimulation and the use of sedatives. Signs and symptoms of Huffing Dizziness Apathy Loss of coordination Nose bleed Head ache Nausea and vomiting Sudden cardiac death Withdraw he brief period of time a drug or alcohol ddict goes through following abrupt ermination in the use of the abused ubstance Nervousness Head and body aches Insomnia Tremors Severe cases result in seizure

8 Treatment of Drug Overdose (1) ote: many drugs have overlapping signs and ymptoms making diagnosis difficult. Protect the Airway Assist with Breathing Ensure adequate Circulation Treatment of Drug Overdose (4) Avoid beta blockers and narcotics in ischemic cardiac conditions Administer benzodiazepines and nitroglycerin Treatment of Drug Overdoses (2) If local guidelines have not been established Contact: Poison Control Provide supportive care while reducing external stimuli and talking down aggressive patients Sedate/administer benzodiazepines to aggressive patients or patients who seize Treat nausea and vomiting with antiemetic Case Study ou are dispatched to local detention center or a 36 y/o female complaining of nausea and omiting that began 12hrs ago. You find the atient febrile and diaphoretic alert only to ainful stimuli. Vitals reveal hypotension and achypnea. EKG reveals an irregular rhythm with wide complex QRS and a regular rate. What additional information would you want o know? How would you treat this patient? Treatment of Drug overdoses (3) Treat dysrhythmias according to ACLS standards with regard to local guidelines Treat hyperthermia with external cooling measures and dantrolene Do Not treat hypertension in the prehospital setting!!! Treat hypotension with fluids If respirations become depressed protect airway and utilize reversal agents if available Case Study 2 y/o woman found unconscious and nresponsive with RR of 6. Track marks resent with weak radial pulses. What additional information would you want to know? How would you treat this patient?

9 Case Study 12 y/o male is found alert and verbal but ow to respond with delayed motor responses. he Pts mother called 911 after the pts nose tarted bleeding and did not stop. Pt has omited twice and is complaining of feeling izzy. The pt is noted to be sticky. What additional information would you want o know? How would you treat this patient? Literary Reference 14). Facts about "bathsalts". Retrieved from Poison Control website: g Enforcement Administration, (2014). Drug fact sheet bath salts or designer cathinones. Retrieved from Drug Enforcement Administration website: g Enforcement Administration, (2014). Cocaine drug fact sheet. Retrieved from Drug Enforcement ministration website: g Enforcement Administration, (2014). LSD drug fact sheet. Retrieved from Drug Enforcement Administration website: w.justice.gov/dea/druuginfo/drug_data_lsd.pdf g Enforcement Administration, (2014). PCP drug fact sheet. Retrieved from Drug Enforcement Administration website: w.justice.gov/dea/druuginfo/drug_data_pcp.pdf g Enforcement Administration, (2014). Peyote and mescaline drug fact sheet. Retrieved from Drug Enforcement ministration website: g Enforcment Administration, (2014). Psilocybin drug fact sheet. Retrieved from Drug Enforcement Administration website: bairn, T., Levy, F., & Sen, A. (2006). Beta-blockers in cocaine induced acute coronary syndrome. Emergency Medical rnal, doi: /emj ucinogens- LSD, Peyote, psilocybin, and PCP. (2008, January 1). National Institute on Drug Abuse. Retrieved January 1, 14, from psilocybin-pcp da, A. (2013). Stimulants. Medscape, Retrieved from kville. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2011). Drug abuse warning network (dawn). Retrieved from website: Summary. Ensure scene is safe. Identify overdose if possible if not categorize as stimulant, depressant, or hallucinogen. Contact Poison Control. Treat signs and symptoms Illustration Reference ://municipalpoliceinstitute.org/wp-content/themes/premiumnews/images/exciteddelirium.jpg :// :// :// ://greenheritagenews.com/wp-content/uploads/2013/02/bath-salts.jpg :// :// ://honisoit.com/wp-content/uploads/2012/08/crystal_meth_rock.jpg ://4.bp.blogspot.com/_rkBr6-tp8V4/Soq9-gH9MVI/AAAAAAAAAOU/j-TargG8wJI/s320/32.jpg :// :// ://growabrain.typepad.com/photos/uncategorized/blotter.jpg ://chemlevel2.wikispaces.com/file/view/lsd_blotter.jpg/ /lsd_blotter.jpg ://fotos.infojardin.com/subida-imagenes/images/bfi m.jpg :// ://zoom50.files.wordpress.com/2011/04/peyote-chips1.jpg :// ://upload.wikimedia.org/wikipedia/commons/e/e3/spice_drug.jpg :// ://images.gizmag.com/hero/opium-poppy.jpg Questions Illustration References ://24.media.tumblr.com/tumblr_mcgd9igJjR1rxu2p3o1_500.jpg :// ://lancaster.unl.edu/family/images/methlab.jpg