Routes of Use. Overdose and EMS. Injection. Ingestion. Inhalation. Absorption 1/2/2013. Injection Ingestion Inhalation Absorption.

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1 Routes of Use Overdose and EMS Injection Ingestion Inhalation Absorption Shaun Pitts, AEMT Venomous bites Common drugs Heroin Cocaine Meth Injection Ingestion Cleaning solutions Household plants Medications ETOH Medications (RX or non RX) Street drugs (Ecstasy) Herbs (Mushrooms) Inhalation Co2 Pesticides Chemicals Tobacco Marijuana Gas Fumes Street drugs (RX drugs) Chemicals Environmental plants Medication patches Street drugs (LSD) Absorption 1

(RX or non RX) Street drugs (Ecstasy) Herbs (Mushrooms) Inhalation Co2 Pesticides Chemicals Tobacco Marijuana

2 What are we seeing on the street K2 spice Herb (synthetic cannabis) increased agitation and vomiting Spice does not cause a positive drug test for cannabis or other illegal drugs Bath Salts white crystals can be swallowed, snorted, smoked, or injected. Can lead to very serious side affects! On the Street Meth Methamphetamine is used as a recreational drug for its euphoric and stimulant properties Labs Cars Hotels Houses What are some signs of a meth lab? Prescription Drugs Are becoming more abused by adults and teenagers Skittle parties Using many types of RX for high When abused has severe side effects Marijuana Medical uses Pain Sleep troubles PTSD Side affects include euphoria and anxiety Becoming legal in many places Safety Issues Labs are unstable! Proper BSI for protection Patients may be violent Excited Delirium -- The Basics Autopsies reveal high levels of Dopamine Drugs block re-uptake of dopamine resulting in higher levels Combined with other mental health issues causes rapid metabolism and acidosis and other imbalances Excited delirium 2

On the Street Meth Methamphetamine is used as a recreational drug for its euphoric and stimulant properties Labs Cars Hotels Houses What are some signs of a meth lab?

3 Excited Delirium Signs and causes Anxiety, hallucinations, disorientation, violent behavior, insensitivity to pain, elevated body temperature, and superhuman strength Cocaine, PCP, methamphetamine, bath salts Personal safety during treatment Do not allow patient to fight against restraints ABC s sudden cardiac arrest is common *NOT-A-CRIME* Acidosis & Rhabdomyolysis Treat the Triad Agitation & Exertion Hyperthermia How do we know what they have taken? Drug Classifications Depressants Alcohol, Valium, Xanax Hallucinogens LSD, PCP, marijuana Opiates: painkillers from opium Heroin, morphine, codeine Stimulants Cocaine, methamphetamine, caffeine What Are The Options For Treatment? BLS O2 for everyone! Contact Medical Control for use of Activated Charcoal Mechanical restraint for combative patients ALS Naloxone (Narcan) Chemical Restraint Sodium Bicarb (tricyclic anti-depressants) Do not lay patients face down for any reason Do not allow patients fight against restraints Withdrawals Alcohol Agitation, palpitations, irritability, tremors, tachycardia Opioids Tremors, cramps, chills, itching, tachycardia Cannabis Anxiety, irritability, increase restlessness Cocaine Paranoia, exhaustion, insomnia 3

Exertion Hyperthermia How do we know what they have taken?

4 Treatment for Withdrawals Supportive care in most cases Monitor and prepare for airway issues Be patient advocate Always be aware patient can become violent Overdose and Pediatrics MOST of the time unintentional Beware of signs of neglect Ask people at the scene lots of questions Common drug ingestions Tylenol Rx medications Alcohol CONTACT POSION CONTROL IMMEDIATELY One Pill/Teaspoon Killers for Pediatrics Theophylline (COPD, Asthma) Tricyclic antidepressants Clonidine (hypertension, ADHD) Verapamil (hypertension, Angina) Propanolol (Hypertension, Angina) Camphor ( topical pain relief) Methyl salicylate (treat joint and muscular pain) Things to Remember SCENE SAFETY! Don t miss clues After safety airway is priority Overdoes becoming common in younger age group Supportive care is most common Stay Safe and Stay Informed Test Questions 1. A common drug that is inhaled is? A. LCD B. Gasoline C. Cocaine D. Heroin 4

for Pediatrics Theophylline (COPD, Asthma) Tricyclic antidepressants Clonidine (hypertension, ADHD) Verapamil (hypertension, Angina) Propanolol (Hypertension, Angina) Camphor ( topical pain relief)

5 2. Signs and symptoms of Excited Delirium can be? A. Super human strength B. High body temperature C. Violent behavior D. All of the above 3. The priority in all overdose calls is what? A. Airway B. Breathing C. Scene Safety D. Patient restraint 4. Excited Delirium can be caused by what drug? A. Marijuana B. Bath salts C. Heroin D. None of the above 5. In the mnemonic NOT A CRIME the O stands for? A. Onset B. Observe C. Objects D. Overdose Happy 100 th! If you have a scenario or case study idea for our 100 th presentation in March, please to Jackie Williams, [email protected]. It should be brief so we can share as many as possible. Wade Scoles and Dr. Jim Nania will be responding to your ideas. Send no later than Friday, February 22 nd. Questions? Contact: Carolyn Stovall [email protected] Fax: Special thanks to Sheila Crow Stitchin Dreams Embroidery [email protected] Updates Please If the name and address of your agency contact has changed, please let us know. This is where we mail your certificates. updated name, address and to: For providing our Secret Question prize Jackie Williams [email protected] 5

In the mnemonic NOT A CRIME the O stands for? A. Onset B. Observe C. Objects D. Overdose Happy 100 th!

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OTC Abuse. Dr. Eman Said Abd-Elkhalek Lecturer of Pharmacology & Toxicology Faculty of Pharmacy Mansoura University

OTC Abuse. Dr. Eman Said Abd-Elkhalek Lecturer of Pharmacology & Toxicology Faculty of Pharmacy Mansoura University OTC Abuse Dr. Eman Said Abd-Elkhalek Lecturer of Pharmacology & Toxicology Faculty of Pharmacy Mansoura University Opiates Abuse Opioids are a group of natural, partially synthetic, or synthetic drugs