Chapter 34 Toxicology & Substance Abuse · Chapter 34 Toxicology & Substance Abuse ... overdose. An estimated 20 ... _____ emergencies. Manage life-threatening ...

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Chapter 34 Toxicology & Substance Abuse

EpidemiologyOver 4 million poisonings occur annually._____________% of ED visits and EMS responses involve toxic exposures.___________% of accidental poisonings occur in children under 6 years old.80% of attempted suicides involve a ______________________________________

overdose. An estimated 20 million people are current users of illicit and synthetic or

“______________________________________ ” drugs

Poison Control CentersPoison Control:National network of specially trained providers.Typically ______________________________________ or statewide.Accessed by telephone.Contact Poison Control Early:Assist in determining potential ______________________________________ .Advise on prehospital treatment.- Poison Control ______________________________________ give orders for drugs

Advise the receiving facility and Medical Control.

Routes of Toxic Exposure Ingestion: orally

– Most common______________________________________ : via respiratory systemSurface Absorption: through the skin______________________________________ : under skin, into muscle, into a blood

vessel

IngestionCommon agents:______________________________________ productsPetroleum-based agentsCleaning agents______________________________________Drugs, plants, or foodsAbsorption occurs in the ______________________________________ and small intestine.

Ingestion Immediate effects of ingestion of ______________________________________

substances (acids or alkalis) can involve burns to the lips, tongue, throat, and esophagus______________________________________ effects result from absorption of poisons

through the GI tracts

InhalationCommon agents:Toxic gases, vapors, fumes, ______________________________________ Carbon monoxide, ______________________________________ , chlorineTear gas, freon, nitrous oxide, methyl chlorideAbsorption occurs via the ______________________________________ —alveolar

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membrane in the lungs.

Surface AbsorptionCommon agents:Poison ivy, oak, or ______________________________________ ______________________________________Absorption occurs through capillaries in the skin.

InjectionCommon agents:Animal bites or ______________________________________ Intentional injection of ______________________________________ drugsSubstance enters directly into the body through a

______________________________________ in the skin.

Standard Toxicologic Emergency ProceduresRecognize a poisoning ______________________________________ .Assess the patient thoroughly to identify the toxin and measures required to control it. Initiate standard treatment procedures.

– Protect rescuer safety.– ______________________________________ the patient from the toxic environment.– Support ABCs.– Decontaminate the patient.– Administer ______________________________________ if one exists.

General AssessmentScene Size-up:Be alert to the potential for ______________________________________ . Look for signs of hazardous-material involvement.Enter a hazardous-materials scene only if properly trained and

______________________________________ to do so.Primary AssessmentAirway and respiratory compromise are common in

______________________________________ emergencies.Manage life-threatening conditions.

General AssessmentHistory, Physical Exam, and Reassessment Identify the toxin and ______________________________________ of exposure.Contact Poison Control and Medical Control according to local policy.Complete appropriate ______________________________________ exams.Monitor vital signs closely.

General Treatment Initiate supportive treatment.______________________________________- Reduce intake of the toxin.Remove the individual from the toxic environment.

- Reduce absorption of toxins in the body.Use gastric ______________________________________ and activated charcoal.

- Enhance elimination of the toxin.

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Use cathartics. (______________________________________ )–Increases gastric ______________________________________

General Treatment______________________________________Useful only if the substance is ______________________________________ .Rarely 100% effective.Must be used in conjunction with other therapies to ensure effectiveness.

General TreatmentSuicidal Patients and Protective Custody: Involve law enforcement. Involve Medical Control.Know local procedures and laws.

– Laws for protective ______________________________________ vary widely. In, Texas, a peace officer or magistrate can place a person in protective custody for up to

___________ hoursPeace officer should ______________________________________ accompany patient in

the ambulance

Assessment of Ingested ToxinsHistory:______________________________________ was ingested?When was it ingested?How much was ingested?Did you drink any alcohol?Have you attempted to ______________________________________ yourself?Have you been under psychiatric care? Why?What is your ______________________________________ ?

Assessment of Ingested ToxinsPhysical exam:Skin______________________________________MouthChestCirculation, EKG______________________________________Exposure to multiple toxinsSuicide attempt, ______________________________________

Management of Ingested ToxinsContact Poison Control/Medical Control.Prevent ______________________________________ .- Consider intubation or RSI

Administer fluids and drugs.– IV access– Use of _______________________, naloxone, and thiamine– Decontamination

Do ______________________________________ induce vomiting.

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- No longer acceptable except in very rare cases

Assessment of Inhaled ToxinsHistory and physical exam:Evaluate the ______________________________________ .Central nervous system effects include dizziness, headache,

______________________________________ , seizure, hallucinations, coma.Respiratory effects include cough, hoarseness, stridor, dyspnea, retractions, wheezing,

chest pain or tightness, rales, ______________________________________ .Cardiac effects include ______________________________________ .

Management of Inhaled ToxinsEnsure your personal safety.

– Do not enter a hazardous scene unless properly trained and equipped to do so.Remove the patient from the ______________________________________ .

– Remove the patient’s ______________________________________ clothing.Perform the initial assessment, history, and physical exam. Initiate ______________________________________ measures. (O2, Intubation)Contact Poison Control and Medical Control according to local protocol.

Assessment and Management of Surface-Absorbed ToxinsEnsure your ______________________________________ safety.

– Do not enter a hazardous scene unless properly trained and equipped to do so.Remove the patient from the environment.

– Remove the patient’s contaminated clothing.– ______________________________________ off dry chemicals– Wash skin with ______________________________________ amounts of water

Assessment and Management of Surface-Absorbed ToxinsPerform the initial assessment, history, and physical exam. Initiate ______________________________________ measures.Contact Poison Control and Medical Control according to local protocol.

Specific Toxins______________________________________A group of typical signs and symptoms consistently associated with exposure to a

particular type of toxinSimilar toxins typically have similar signs and symptoms. In some cases it may be ______________________________________ to identify a

specific toxin but identification of a toxidrome may be achievable

Cyanide______________________________________ -acting toxinCommon in ______________________________________ , silver polish, fruit pits,

burning plasticsClassified as a cellular ______________________________________ Usually ingested, absorbed, or inhaledSigns & Symptoms:Burning sensation in the mouth and throatHeadache, confusion, and combativeness______________________________________ and tachycardia

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Seizures and comaPulmonary edema

CyanideManagementEnsure rescuer safety. Initiate ______________________________________ care.Administer antidote:

– Cyanide antidote kit containing amyl ______________________________________ , sodium nitrite, and sodium thiosulfate

Carbon Monoxide Inhaled colorless, odorless gas that is a product of

______________________________________ combustionChemical asphyxiant

– Poorly ventilated heating systems– Confined spaces

It has more than 200 times the affinity of oxygen to bind with the red blood cells ______________________________________

Carbon MonoxideSigns & Symptoms:______________________________________Nausea and vomitingConfusion or other altered mental status____________________________________________________________________________ in earsBright cherry red skin- Very late sign

Carbon MonoxideManagement:Ensure rescuer safety.Remove the ______________________________________ from the contaminated area. Initiate supportive measures.- High-flow oxygen

______________________________________ therapy

Cardiac MedicationsNumerous typesCommonly due to ______________________________________ errorsSigns & Symptoms:Nausea, vomiting, headache, dizziness, confusionProfound ______________________________________ , cardiac dysrhythmias______________________________________, pulmonary edemaManagement:General toxicologic emergency proceduresAntidotes?

Caustic SubstancesTypically occurs by ingestion or ______________________________________ absorption.

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______________________________________- Cause significant damage at sites of exposure.- Are rapidly absorbed into the bloodstream.

______________________________________– Slower onset of symptoms allows for longer contact and more extensive tissue damage.

Caustic SubstancesSigns & SymptomsFacial ______________________________________ Pain in the lips, tongue, throat, or gums______________________________________, trouble swallowingHoarseness, ______________________________________ , or shortness of breathShock from bleeding, vomitingManagement:Perform standard toxicologic emergency procedures.Maintain an adequate airway.Avoid ______________________________________ airways

Hydrofluoric AcidUsed to clean and etch ______________________________________ .Highly toxic despite the appearance of only moderate

______________________________________ on skin contactPenetrates deeply into tissues and disrupts cell function and can be destructive to

______________________________________ Signs & Symptoms- Burning at site of contact- Confusion, ______________________________________ , muscle cramps

Hydrofluoric AcidManagementScene safetySupportive measuresRemove ______________________________________ clothing Irrigate and ______________________________________ the affected area.Transport immediately for definitive care.

HydrocarbonsCompounds of Carbon and Hydrogen

– Kerosene, naphtha, ______________________________________ , mineral oil, chloroform, toluene, benzene

Found in common household products like lighter fluid, paint, ______________________________________ , lubricants, solvents, and aerosol propellants

May be ingested, inhaled, or absorbed.

HydrocarbonsSigns & Symptoms- ______________________________________ due to local contact- Wheezing, dyspnea, hypoxia, pneumonitis- Headache, dizziness, slurred speech, ataxia, cardiac dysrhythmias- Foot and ______________________________________ drop with numbness and

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tinglingManagement- Standard toxicologic emergency procedures

Tricyclic AntidepressantsAntidepressants: Include amitriptyline, amoxapine, doxepin, nortriptyline, imipramine, clomipramine.TCAs have a ______________________________________ therapeutic index.- A small increase in dose can quickly lead to toxic effects

Signs & Symptoms of Toxicity- Dry mouth, blurred vision, ______________________________________ retention,

constipation

Tricyclic AntidepressantsSigns & Symptoms of Severe Toxicity:Confusion, ______________________________________ , hyperthermiaRespiratory depression, seizuresTachycardia, ______________________________________ , cardiac dysrhythmiasManagement:Perform standard toxicologic emergency procedures.Monitor and treat cardiac ______________________________________ .Avoid use of flumazenil, which may precipitate

______________________________________ .Consider administration of Sodium Bicarbonate

MAO InhibitorsMonoamine oxidase inhibitors Infrequently prescribed ______________________________________ but used, on a

limited basis to treat O/C disorders- High ______________________________________ with overdose because of drug’s

action- Very narrow therapeutic ______________________________________ - Serious ______________________________________ with many other drugs- Serious interactions with foods containing

______________________________________ such as red wine and cheese

MAO InhibitorsSigns & Symptoms:Headache, agitation, restlessness, ______________________________________ Nausea, severe hypertension, ______________________________________ ______________________________________ and tachycardia

– Progresses to ______________________________________ , hypotension, coma, and death.

Management:Standard toxicologic emergency procedures

Newer AntidepressantsAlmost have completely replaced tricyclic antidepressantsCommon Names:Trazodone (Desyrel) Bupropion (______________________________________ )

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SSRIs (selective serotonin re-uptake inhibitors)– ______________________________________, Luvox, Zoloft, and Paxil

Newer AntidepressantsSigns & Symptoms of OD:Drowsiness, tremor, nausea, vomiting, tachycardiaSerotonin ______________________________________

– Triggered by increasing the dose or by adding selected drugs.– Marked by ______________________________________ , anxiety, confusion,

insomnia, headache, coma, salivation, diarrhea, abdominal cramps, flushed skin, hyperthermia, rigidity, shivering, incoordination, and myoclonic jerks.

Newer AntidepressantsOD is not as life threatening as with previous antidepressants unless other drugs or

______________________________________ is taken– ______________________________________– Codeine

Management of OD: Standard toxicologic emergency procedures

LithiumPrescribed to treat ______________________________________ disorder.- Narrow therapeutic index

Signs & Symptoms of OD- Thirst, dry mouth, tremors, muscle twitching, and increased

______________________________________ - Confusion, stupor, seizures, coma, nausea, vomiting, diarrhea, bradycardia, and

______________________________________ Treatment- Standard toxicologic emergency proceduresActivated ______________________________________ is not effective with lithium

SalicylatesCommon Overdose Drug- Includes ______________________________________ , oil of wintergreen.

Signs & Symptoms- Tachypnea, hyperthermia, confusion, lethargy, coma, cardiac failure, and dysrhythmias- Abdominal pain, vomiting, pulmonary edema,

______________________________________ Treatment- Standard toxicologic emergency proceduresActivated charcoal is ______________________________________ .

AcetaminophenCommon OTC Antipyretic & AnalgesicSigns & Symptoms of OD:Stage 1 (1/2 hour to 24 hours)

– Nausea, vomiting, weakness, ______________________________________ Stage 2 (24-48 hours)

– Abdominal pain, decreased urine, elevated ______________________________________ enzyme

Stage 3 (72-96 hours)

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– Liver function ______________________________________ Stage 4 (4-14 days)

– Gradual recovery or progressive liver ______________________________________

AcetaminophenTreatment:Standard toxicologic emergency procedures______________________________________ is available- N-acetylcyseine (NAC)

BenzodiazepinesSedatives:

– Valium, Ativan, VersedAffects the ______________________________________ Common form of ODMost significant S/S is ______________________________________ depression or arrestReversed with ______________________________________

FlumazenilAKA: RomaziconBenzodiazepine receptor ______________________________________ , antidoteReverses the effects of bezodiazepines Indications: Benzodiazepine overdoseContraindications: cyclic ______________________________________ OD, status

epilepticus

FlumazenilAdult Dosage: ____________mg IV/IO over 15 seconds (SIVP)

– May be repeated a total of 4 times (1mg total)Pedi (>1YOA) Dosage: 0.01mg/kg IV/IO over 15 seconds (SIVP)

– May be repeated to a maximum of 0.05mg/kgSide Effects: ______________________________________ , dizziness, pain at injection

site, headache, visual disturbancesMay produce ______________________________________

Other Nonprescription Pain Medications Includes Nonsteroidal Anti-inflammatory Drugs- NSAIDs include ______________________________________ , keterolac, naproxen

sodium.Signs & Symptoms of OD- Headache, tinnitus, nausea, vomiting, ______________________________________

pain, drowsiness- Dyspnea, wheezing, ______________________________________ edema, swelling of

extremities, rash, itchingTreatment- Standard toxicologic emergency procedures

Theophylline______________________________________ Prescribed for Chronic Respiratory

ProblemsSigns & Symptoms of OD

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- Agitation, tremors, seizures, cardiac ______________________________________ , nausea, and vomiting

Management:Standard toxicologic emergency procedures

– Repeated doses of activated ______________________________________ are indicated.

– Treat cardiac dysrhythmias.

Metals: IronOverdose of dietary supplementSigns & Symptoms

– ______________________________________(with hematemesis), diarrhea, abdominal pain, shock, liver failure, bowel scarring and obstruction, metabolic ______________________________________ with tachypnea

Treatment– Standard toxicologic emergency proceduresActivated charcoal is not indicated.

Metals: Lead and MercuryOverdose often results from ______________________________________ environmental

exposure.Signs & Symptoms

– Headache, irritability, confusion, coma, ______________________________________ disturbances, tremors, weakness, agitation, abdominal pain

Treatment– Standard toxicologic emergency proceduresActivated charcoal is not indicated.

Contaminated FoodBacteria, Viruses, and Toxic ChemicalsBacterial Toxins

– ______________________________________ : poison secreted during growth of a bacterium

– ______________________________________ : an exotoxin that produces GI symptoms

– Incubation period is 4 hours to 8 days– Shigella, Salmonella, E. coli, Botulism

Contaminated FoodSeafood Poisonings- ______________________________________ Shellfish Poisoning: contaminated clams,

mussels, oysters, and scallops• Can lead to respiratory failure

- Other types of seafood poisoningsSigns & Symptoms of contaminated foods- Nausea, vomiting, ______________________________________ , and abdominal pain- ______________________________________ flushing and respiratory distress

Contaminated FoodTreatmentPerform assessment.

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Collect ______________________________________ of the suspect food source.Maintain the airway and support breathing.

– ______________________________________ and assist ventilations if indicated.– Administer high-flow oxygen.

Establish IV access and monitor ECG.Consider medications.

– Antihistamines, ______________________________________

Poisonous Plants and MushroomsDecorative Plants- Common source of accidental poisoning in

______________________________________ Toxic ______________________________________ - Amanita and Galerinal belong to the deadly cyclopeptide group- Mortality rate of __________%

Poisonous Plants and MushroomsSigns & Symptoms of poisoning - Excessive ______________________________________ , lacrimation, diaphoresis,

abdominal ______________________________________ , nausea, vomiting, diarrhea, and altered mental status

Treatment- Follow treatment guidelines for contaminated food.- Take sample of plant or mushroom if possible

Injected ToxinsGeneral Principles of ManagementProtect rescuers.Remove the patient from ______________________________________ . Identify the ______________________________________ that caused the injury.Perform an initial assessment and rapid physical exam.Prevent or delay ______________________________________ of the poison.

Injected ToxinsGeneral Principles of Management (Cont’d) Initiate ______________________________________ measures as indicated.Watch for ______________________________________ reactions.Transport the patient rapidly.Contact Poison Control and Medical Control.

Insect Bites and StingsSigns & Symptoms Localized pain, redness, swelling, skin ______________________________________ .

– ______________________________________ reactionsObserve for signs of an allergic reaction.

– Localized pain, redness, swelling, skin wheal– Generalized ______________________________________ of the skin or itching– Tachycardia, hypotension, bronchospasm, or laryngeal edema, facial edema, uvular

swelling

Insect Bites and Stings

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Treatment:Wash the area.Remove ______________________________________ , if present.

– Use care not to disturb the venom sac.Apply ______________________________________ compresses to the injection site.Observe for and treat allergic reactions and/or anaphylaxis.

Brown Recluse Spider BitesFound primarily in the ______________________________________ and Midwest.Bites are normally ______________________________________

Brown Recluse Spider BitesSigns & Symptoms Localized, white-ringed ______________________________________ .Progresses to localized pain, redness, and swelling over next ____________ hours.Chills, fever, nausea, vomiting, and ______________________________________ pain

may also develop.

Brown Recluse Spider BitesSigns & Symptoms (cont’d)Tissue ______________________________________ develops over subsequent days and

weeks.Treatment

– Follow general treatment guidelines.– Provide ______________________________________ care.– Definitive treatment is surgical excision

Brown Recluse Spider Bite: Initial Appearance (Day 1)

Brown Recluse Spider Bite: Day 3

Brown Recluse Spider Bite: Day 5

Brown Recluse Spider Bite: Day 6

Brown Recluse Spider Bite: Day 9

Brown Recluse Spider Bite: Day 10

Black Widow Spider BitesSigns & Symptoms______________________________________ pain, redness, and swellingProgressive muscle ______________________________________ of all large muscle

groupsNausea, vomiting, sweating, seizures, ______________________________________ , and

altered level of consciousness

Black Widow Spider BitesTreatment:Follow general treatment guidelines.Provide supportive care.Consider using muscle ______________________________________ to relieve severe

muscle spasms.– ______________________________________ 2.5–10mg IV or 0.1–0.2 mg/kg of a 10%

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calcium ______________________________________ solution IVAntivenin available (______________________________________ Mactans) for sick and

feeble

Scorpion StingsOnly the bark scorpion has caused fatalities in USSigns & Symptoms Localized burning and ______________________________________ sensationSlurred speech, restlessness, muscle twitching, salivation, nausea, vomiting, and seizures

Scorpion StingsTreatment:Follow general treatment guidelines.Apply ______________________________________ band above sting siteAvoid analgesics, which could increase toxicity

SnakebitesPit Viper Bites- Venom destroys ______________________________________ and other tissue

components.Coral Snake Bites- Venom is a ______________________________________ that results in paralysis.

Management of Pit Viper BitesPrimary goal is to ______________________________________ absorption About 25% of bites are “______________________________________ ”Amount of venom varies significantlyEnvenomation is “all or nothing”Time is required to produce additional venomTreatment is dependant on ______________________________________

Degrees of Envenomation of Pit Viper BitesNone: produces only ______________________________________ s/sMinimal: Pain, swelling, no ______________________________________ symptomsModerate: progressive swelling with mild systemic symptoms

– Nausea Vomiting– Unusual tastes– Mild hypotension– Mild tachycardia– ______________________________________

Degrees of Envenomation of Pit Viper BitesSevere

– ______________________________________(spreading rapidly)– Severe pain– Systemic symptomsAMSNausea/vomitingHypotensionSevere ______________________________________ Severe respiratory distress

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– ______________________________________ oozes freely from wounds

Treatment of Pit Viper BitesKeep the patient ______________________________________ . Immobilize the injured limb and maintain it in a neutral position.Apply high-flow oxygen.Establish IV access; give pain medsDo not use a ______________________________________ kitTransport.DO NOT apply constricting bands, ______________________________________ , cold

packs, tourniquets, or electrical stimulation to the wound.______________________________________ is available

Coral SnakesSmall snake with red, yellow, and black bands “Red on yellow will kill a fellow, red on black, venom will lack.” Injects venom with teeth, using a ______________________________________ motion

that leaves puncture wounds

Coral SnakesVenom causes ______________________________________ of the respiratory and

skeletal system.Can produce bizarre behavior.Paralysis of eye movement and ______________________________________ ______________________________________ redness and swelling.

Coral Snake BitesSigns & Symptoms: Localized numbness, weakness, drowsiness, ataxia, slurred speech, excessive salivation,

paralysis of the ______________________________________ and larynxDrooping of the eyelids, double vision, dilated pupils, abdominal pain, nausea, vomiting,

loss of consciousness, ______________________________________ , respiratory failure, hypotension

Treatment of Coral Snake BitesTreat similarly to a pit viper bite

– ______________________________________ elevation– No ______________________________________ – No constricting bands

Wash the wound with large amounts of ______________________________________ and maintain the immobilized extremity at the level of the heart.

Treat S/S

Marine Animal Injection Jellyfish, corals, sea urchins, and ______________________________________ All venoms of marine animals contain substances that produce pain out of

______________________________________ to the size of the injuryPoisons are unstable and ______________________________________ sensitivePossibility of ______________________________________ infection due to viral and

bacterial contamination

Marine Animal Injection

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Signs & Symptoms Intense ______________________________________ pain and swellingNausea and vomitingDyspneaTachycardia______________________________________ or shock in severe casesTreatment:Establish and maintain the airway.Apply a ______________________________________ band above the site.Apply heat or hot ______________________________________ .Inactivate or remove any ______________________________________ .

Substance Abuse and OverdoseTerms:Substance abuse: use of a pharmacological substance for purposes

______________________________________ than medically defined reasons______________________________________ : compulsive and overwhelming

dependence on a drug- Physiological dependence- Psychological dependence

______________________________________ : the need to progressively increase the dose of a drug to produce the desired effect

______________________________________ : body’s response when deprived of substance

Narcotics/OpiatesDerived from the ______________________________________ plant Includes Morphine, Fentanyl, Demerol, Hydrocodone, Oxycotin, and Heroin______________________________________ depression is of most concernEffects can be reversed with Narcan

CocaineThe most potent ______________________________________ of natural originExtracted from the leaves of the ______________________________________ plantAlso used as a topical ______________________________________ Has the highest use among adults age 26 and older

Cocaine “______________________________________ ” is the freebase from of cocaine Most often inhaled or ______________________________________ Common street names include: “Coke”, “Snow”, “Flake”, and “Blow”

Effects of Cocaine Increases alertness and ______________________________________ Constricted blood vesselsDilated pupils______________________________________ and hypertensionHyperactivity, anxiety and paranoia______________________________________ Long term use can cause erosion of nasal septum

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MethamphetaminesA derivative of amphetamineA powerful ______________________________________ that affects the CNSCan be smoked, ______________________________________ , ingested, or injectedMany forms and colors

MethamphetaminesCan be made easily with readily available ingredients with a base of

______________________________________ ______________________________________ are easily obtainable on the internet______________________________________ process can pose hazardous materials

situationsStreet names include “Speed”, “Meth”, “Chalk”, “Ice”, “Crystal”, “Glass”, “Tina”

Effects of Methamphetamines Increased wakefulness (insomnia) and activityDecreased ______________________________________ Increased respirations, pulse, and BP Irritability, aggression, paranoiaHyperthermia and seizures may result in death______________________________________ Chronic users may develop ______________________________________ behavior,

hallucinations, rage, and violent behavior, and “meth mouth”

Other Dangers with Meth______________________________________ drug labs can be found anywhereA popular ingredient is anhydrous ammonia which is an asphyxiantMany of the chemicals are ______________________________________ , flammable, or

otherwise hazardousCriminals with firearms______________________________________ traps

HallucinogensPsychoactive drugs that causes changes to ______________________________________

, thought, emotion, and consciousness3 categories: psychedelics, dissociatives, and deliriantsBiggest danger is a “bad trip” “______________________________________ the patient down”Use physical and/or chemical ______________________________________ as necessaryUse Benzodiazipines if seizing

MDMA (Ecstasy)MDMA is predominantly a “______________________________________ drug” and is

commonly used at all-night dance parties known as “raves.” MDMA is moving to settings other than nightclubs, such as private homes, high schools,

and college dorms.

MDMA (Ecstasy)A ______________________________________ similar to amphetamines and induces

euphoria and intimacyCommon street names include: “X”, “XTC”, “Adam”, “Hug”, “Beans”, “Love Drug”

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Effects of MDMAPsychological Effects:Mood alteration, confusion, sleep, anxietyPoor ______________________________________ , poor impulse controlHallucinations, Paranoia, and DelusionsTolerancePhysical Effects:MI, ______________________________________ , CVASeizures Muscle tension______________________________________ up to 109°

RohypnolOften used as a date rape or ______________________________________ drugFlunitrazepamA ______________________________________ marketed in Mexico and South AmericaUsed for insomnia

Rohypnol● 10 times more potent than ______________________________________ ● Full effects reached in 20 minutes● Duration up to 8 to 12 hours● Colorless, ______________________________________ and odorless● Can be dissolved in a drink without detection● ______________________________________ intensifies effects● Can be ingested, injected, or snorted● Street names include “Rophies”, “Roofies”, “Roach”, and “Rope”

Effects of RohypnolCNS ______________________________________ Amnesia and confusion______________________________________ depressionMuscle relaxationMay be lethal when mixed with alcohol or other depressants______________________________________ and hypotensionHas been known to induce aggression

KetamineKetalarUsed as an ______________________________________ and often misused as a date

rape or predator drugWidely used in ______________________________________ practice

KetamineUsed in human anesthesiaDuration up to 24 hours______________________________________ effects last 45–90 minutes Liquid is colorless and odorlessAlso can be a powder, pill, or ______________________________________ Street names include “K”, “Special K”, “Vitamin K”, “Jet”, “Green”, “Kay”, “Mauve”, “Special

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LA”, “Super Acid”, “Bump”

Effects of Ketamine______________________________________ DeliriumAmnesiaBody DissociationRespiratory ______________________________________ ______________________________________ ArrhythmiasCardiac arrestHypertension

GHBGamma-HydroxybutyrateAlso used as a date rape or predator drugCNS ______________________________________ and intoxicantWas available ______________________________________ until 1992 as an amino acid

supplement

GHB______________________________________ in 15–30 minutesDuration of up to 3 hours ______________________________________ or liquid that is odorless and tastelessStreet names include “Georgia Home Boy”, “Grievous Bodily Harm”, “Liquid Ecstasy”,

“Soap”, “Vita G”, “Easy Lay”

Effects of GHBRelaxation and tranquility______________________________________ and confusionSensuality and a loss of inhibitionsHallucinations______________________________________ Bradycardia and hypotension

MarijuanaSmoked by 20 million people daily in the USProduces euphoria, ______________________________________ , and drowsiness Impairs short-term memory and ability to workTransport to hospital is rarely needed.Marijuana can be used as ______________________________________ for other drugs

– It can be covered with PCP, crack, or other drugs.

Other Common Drugs of Abuse______________________________________

– Respiratory support is main concern– Use ______________________________________ to counteract adverse effects– Be careful not to cause withdrawal

______________________________________– Respiratory support is main concern– Forced ______________________________________ will increase elimination

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Synthetic DrugsAlthough many legitimate drugs are synthetic, or made in a lab, the context of synthetic

drugs in this sense deals with the illicit use or “designer” drugsMost common types are ______________________________________salts and synthetic

marijuana Can be highly ______________________________________

Synthetic DrugsMany of these drugs are sold ______________________________________in the USThere are many attempts to outlaw and regulate these drugs Legislation is extremely difficult to enforce due to

______________________________________and ingredients – Most are labeled “not for human consumption”

Normally sold at ______________________________________and “head” shops

Synthetic DrugsOne of the main problems with these drugs is the inconsistency of ingredients and the

inconsistency of the ______________________________________Perception by many is if it is legal, then it can’t be too dangerousGrowing problem nationwide that has resulted in

______________________________________of deaths, injuries, and hospitalizationsEffects of long term use are ______________________________________

Bath SaltsHave nothing to do with real bath saltsMany contain Methylenedioxpyrovalerone (______________________________________)

– A ______________________________________drug with stimulant properties which acts as a norepinephrine-dopamine reuptake inhibitor

Bath SaltsCommon street names include “Ivory Wave”, “Purple Wave”, “Vanilla Sky”, and “Bliss”Sometimes packaged as “jewelry cleaner”,

“______________________________________food”, or “phone screen cleaner”Taken by ingestion, ______________________________________, and snortingCommon effects include agitation, hallucinations, seizures, paranoia, chest pain,

______________________________________, hypertension, and suicidal thinking/behavior

Bath Salts______________________________________thinking/behavior may last even after the

stimulatory effects have worn off– Suicides and suicide attempts have been reported days after use

Effects are ______________________________________even when taking the same brand and same dose

Synthetic MarijuanaA psychoactive designer drug mostly derived from natural

______________________________________sprayed with synthetic chemicals; designed to mimic the effects of marijuana

Marketed as “herbal ______________________________________” or “herbal smoking blends”

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Synthetic MarijuanaStreet names include “______________________________________, “K-2”, “Black

Mamba”, “Bombay Blue”, “Fake Weed”, “Genie”, “Blaze”, “Zohia”, and numerous others______________________________________ingredients used to create effects ______________________________________are often inaccurate

Synthetic MarijuanaEffects are designed to be similar to

______________________________________marijuanaEffects may be ______________________________________Adverse effects include agitation, hallucinations, seizures, paranoia, chest pain,

tachydysrhythmias, hypertension, and suicidal thinking/behavior

Inhalants Inhalants may be any of thousands of household itemsHas ______________________________________ effectsCommon products include aerosols, paint, glue, white out, gasoline, etherTermed “______________________________________ ” or “sniffing”

Effects of Inhalants (1 of 2)Effects range from mild drowsiness to ______________________________________ ______________________________________ by person and substance inhaledMay often cause seizures and dysrhythmiasCommon effects include aggression, “super human” strength, and paranoia______________________________________ depression or arrestCardiac dysrhythmias

Effects of Inhalants (2 of 2)Halogenated hydrocarbon (______________________________________ ) solvents can

make the heart hypersensitive to the patient’s own adrenaline. BE GENTLEEven the action of ______________________________________ may cause a fatal

ventricular arrhythmia and cardiac arrest.Sudden ______________________________________ can result from a single session of

inhalant useChronic use can cause damage to the brain, liver, and kidneys

Management of Drug Abuse (1 of 3)Management of most drug overdoses and adverse reactions will be

______________________________________ Narcan is ineffective except for ______________________________________ Management will depend on the S/SProtecting the patient and crew from ______________________________________ is

paramount– These people may be dangerous

Management of Drug Abuse (2 of 3)Maintain a ______________________________________ environment and talk patient

down if anxious or hallucinatingOxygen and protect airway IV at appropriate rate

– Avoid massive fluids if ______________________________________

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Monitor ECG and ______________________________________ lethal dysrhythmias Don’t allow the patient to walk or be physically active

Management of Drug Abuse (3 of 3) If inhalant use is suspected, be mindful of ______________________________________

cardiac arrest– Even the action of ______________________________________ can trigger a lethal

ventricular dysrhythmia Identify the substance, dose, route, and time taken if possible If severe hyperthermic (105° or above), ______________________________________

the patient immediately

Alcohol AbusePhysiologic Effects:CNS ______________________________________ AlcoholismSusceptible to ______________________________________ or ethylene glycol

ingestionPeripheral vasodilation, ______________________________________

General Alcoholic ProfileDrinks early in the day, alone, or ______________________________________ .Binges, blackouts, GI problems, “green tongue syndrome,” chronic flushing of face and

palms.______________________________________ burns, tremulousness, and odor of alcohol.

Alcohol AbuseConsequences of Chronic Alcohol Ingestion:Poor ______________________________________ Alcohol hepatitis Liver ______________________________________ , pancreatitisSensory loss in hands/feet Loss of balance and coordinationUpper GI hemorrhage______________________________________Falls (fractures and subdural hematoma)

Alcohol Abuse

Alcohol Withdrawal SyndromeDelirium Tremens (DTs)Signs & Symptoms

– Coarse tremor of ______________________________________ , tongue, eyelids– Nausea, vomiting, general weakness, anxiety– Tachycardia, sweating, ______________________________________ , hallucinations,

irritability or depressed mood, poor sleep– Increased sympathetic tone, ______________________________________ hypotension

Treatment of Alcohol AbuseEstablish and maintain the airway.Determine if other ______________________________________ are involved.Establish IV access.

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– Lactated Ringer’s or normal salineConsider medications.

– 25g D50W if hypoglycemic– 100mg ______________________________________ IV or IM

Transport, maintaining a sympathetic attitude, and reassure the patient.