Club DrugsThe Prehospital Perspective
Steven Katz, M.D., FACEP, EMT-PAssociate Medical Director
Palm Beach County Fire Rescue
PresidentNational Paramedic Institute
EMS Case Study
HPI 18 year-old girl
returns from late-night 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
Physical ExamGeneral: unresponsive, flaccid,
lying in pool of vomitHEENT: unremarkable, no
evidence of traumaLungs: agonal respirationsCardiac: tachycardic, regularAbdomen: soft, no apparent
tendernessBack: unremarkableExtremities: no evidence of
trauma, no pedal edemaSkin: dry, covered in vomitNeuro: unresponsive, nonverbal
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 well-secured.
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 DrugsSummary
• Scene Safety
• Airway
• Be aware for sudden changes
• Continuosly monitor
• Be thoroughScene surveyHistoryPhysical ExamTalk to Bystanders