Download CBT 442 Stroke

Overview of CBT 937
Street Medicine – Street Drugs
Complete course available at www.emsonline.net
Copyright 2009 Seattle/King County EMS
Introduction
Street Drugs
• Trends in substance abuse are constantly
changing
• Change is even more rapidly today due to easily
accessible information on the Internet
Copyright 2009 Seattle/King County EMS
Practical Skills
To receive CBT or OTEP credit, you must perform the
following practical skills:
• Airway maintenance protection
• Assisted ventilation of patient with respiratory
depression or respiratory arrest
A roundtable discussion is optional at the discretion of the training officer
and evaluator. See skills checklist on EMS Online Downloads page.
Copyright 2009 Seattle/King County EMS
Terms
agonist — A substance that produces a specific action in the
body by binding with a cell receptor, for example heroin.
antagonist — A substance that blocks cell receptors
preventing the physiological response of another substance.
For example, Narcan (naloxone) is an antagonist to the opioid
class of drugs.
benzodiazepine — A class of medications that causes
sedation. Uses include: anesthesia, treatment of seizures,
treatment of serious anxiety or panic disorders and
management of insomnia.
dependence — A physical or psychological condition where
the body requires a particular substance or chemical without
which it reacts adversely.
Copyright 2009 Seattle/King County EMS
Terms, continued
huffing — The purposeful inhalation of chemical vapors to
achieve an altered mental or physical state, also called dusting,
snorting or sniffing.
nystagmus — An unintentional, beating movement of the
eyes where the eyes track in one direction and then move back
mid-view repeatedly.
opioid — A class of drugs that acts on the opioid receptors.
Opioids receptors can inhibit pain and potentially cause
symptoms of sedation, respiratory depression or euphoria.
sympathomimetics — A class of drugs that stimulate the
sympathetic nervous system. The also are called CNS
stimulants. Examples are cocaine, caffeine and Ecstasy.
Copyright 2009 Seattle/King County EMS
How Drugs Work
Drug-receptor interaction is like lock and key
Copyright 2009 Seattle/King County EMS
How Drugs Work, cont.
Drug molecules are carried by the circulatory
system to receptor sites in body tissues
Copyright 2009 Seattle/King County EMS
How Drugs Work, cont.
It is here that the drug molecules bind with the
cell receptor and produce an action
Copyright 2009 Seattle/King County EMS
Agonists
Drugs that produce a specific action by binding
with a receptor are agonists
Copyright 2009 Seattle/King County EMS
Antagonists
Drugs that block the body's own substances
from fitting into a cell’s receptors are
antagonists
Copyright 2009 Seattle/King County EMS
Prescription Pain Medications
• Upward trend in misuse of prescription drugs
is an increasing health and safety problem
esp. among teenagers and young adults
• Vicodin, OxyContin and methadone account
for a large percentage
Copyright 2009 Seattle/King County EMS
Inhalants
• Trend among children and adolescents
• Chemical vapors can produce mind-altering
effects
• “Huffing” or “sniffing”
• Gasoline, glues, sprays, nail polish, hair
spray, cleaning fluids and butane
Copyright 2009 Seattle/King County EMS
Club Drugs
• Used by teenagers and young adults at
nightclubs, bars, parties and raves.
• Ecstasy, GHB, Rohypnol, LSD and ketamine
Image credit: © iStockphoto
Copyright 2009 Seattle/King County EMS
Over-the-Counter Medications
• Cough medicines, diet pills, motion sickness
pills and sleep aids
• Cough and cold meds contain
dextromethorphan (DXM) a nervous system
depressant
Copyright 2009 Seattle/King County EMS
Alcohol
• Most commonly abused and potentially
dangerous substance
• Depressant qualities
• Causes severe CNS depression and death
Copyright 2009 Seattle/King County EMS
Classes of Street Drugs
•
•
•
•
•
Opioids
CNS stimulants
Depressants
Hallucinogens
Inhalants
Copyright 2009 Seattle/King County EMS
Opioids
• Morphine-like action in the body
• Suppress CNS
• Prescribed for pain relief
Copyright 2009 Seattle/King County EMS
Opioids, continued
•
•
•
•
•
•
•
•
•
Heroin
Morphine
Methadone
Vicodin
OxyContin
Codeine
Demerol
Darvon
Dilaudid
Copyright 2009 Seattle/King County EMS
CNS Stimulants
• Activate sympathetic nervous system and
CNS
• Mimic effect of epinephrine
• Increase heart rate, constrict blood vessels
and elevate BP and increase the work of
heart
• Can raise body temperature and cause
cardiac dysrhythmias
Copyright 2009 Seattle/King County EMS
CNS Stimulants, continued
•
•
•
•
•
•
•
Cocaine
Crack cocaine
Methamphetamine
Ecstasy
Amphetamines
Ritalin
Dexedrine
Copyright 2009 Seattle/King County EMS
Depressants
• Sedate or depress CNS
• Treat anxiety and insomnia
• Abused by patient or gets into hands of
someone who abuses them
• Effects include sedation, mild euphoria, loss
of inhibition, relaxation and poor judgment
Copyright 2009 Seattle/King County EMS
Depressants, continued
•
•
•
•
•
•
•
•
•
•
Barbiturates
DXM
Xanax
Librium
Valium
Ativan
Klonopin
Rohypnol
Ambien
GHB
Image credit: Public domain, Kodak Photodisc
Copyright 2009 Seattle/King County EMS
Hallucinogens
• Alter perception, thought or mood
• Effects: anxiety, panic, irrational behavior
and psychosis
• Can lead to injury to both the patient and
responders
Copyright 2009 Seattle/King County EMS
Hallucinogens, continued
•
•
•
•
•
•
LSD
PCP
Ketamine
Mescaline
Peyote
Psilocybin mushrooms
Use extreme caution!
Hallucinogens can cause unpredictable behavior.
Copyright 2009 Seattle/King County EMS
Inhalants
• Volatile solvents, aerosols and gases
• Sniffed to produce a state that resembles
alcohol intoxication
• Effects: initial excitation, drowsiness,
lightheadedness and agitation, loss of
consciousness
Copyright 2009 Seattle/King County EMS
Inhalants, continued
Volatile solvents
•
•
•
•
•
•
•
•
•
Paint thinners
Paint removers
Degreasers
Dry-cleaning fluids
Gasoline
Lighter fluid
Correction fluid
Felt tip markers
Glue
Copyright 2009 Seattle/King County EMS
Inhalants, continued
Aerosols
•
•
•
•
•
Hair spray
Deodorant spray
Vegetable oil spray
Fabric protector spray
Spray paint
Copyright 2009 Seattle/King County EMS
Inhalants, continued
Gases
•
•
•
•
•
•
•
•
•
Nitrous oxide
Propane gas
Computer keyboard cleaner
Ether
Chloroform
Halothane
Butane
Propane
Whipped cream dispensers (nitrous oxide)
Copyright 2009 Seattle/King County EMS
Scene Safety
•
•
•
•
•
•
Be aware of what’s going on around you
Request police assistance
Approach doors from the side
Scope out two exits
Be alert to changes in patient’s demeanor
Leave patient an exit (don’t stand between
him and the door)
Copyright 2009 Seattle/King County EMS
Assessment
• Combining intoxicants is common
• Mixed presentation of signs and symptom
• Often unpredictable and dangerous
Copyright 2009 Seattle/King County EMS
Street Drugs - Effects
Opioids
•
•
•
•
•
•
•
Shallow respirations
Slow respiratory rate
Hypotension
Pinpoint pupils
Lethargy
Respiratory arrest
Coma
Copyright 2009 Seattle/King County EMS
CNS stimulants
•
•
•
•
•
•
•
•
•
•
Hypertension
Tachycardia
Cardiac dysrhythmias
Hyperthermia
Sweaty skin
Dilated pupils
Seizures, rigidity
Agitation
Delusions
Paranoia
Street Drugs - Effects, continued
Depressants
•
•
•
•
•
•
•
Shallow respirations
Slow respiratory rate
Hypotension
Lethargy, stupor
Slurred speech
Sedation
Coma
Copyright 2009 Seattle/King County EMS
Hallucinogens
•
•
•
•
•
•
•
Tachycardia
Tachypnea
Hypertension
Panic
Seizures
Visual illusions
Disorientation
Street Drugs - Effects, continued
Inhalants
•
•
•
•
•
Cardiac dysrhythmias
Tingling
Numbness
Swollen membranes
Coma
Copyright 2009 Seattle/King County EMS
Immediate Threats to Life
Opioids
Respiratory depression/arrest
Hypotension
CNS stimulants
Cardiac dysrhythmias
Seizures
Depressants
Decreased level of consciousness
Respiratory depression
Hallucinogens
Self-inflicted trauma
Violence
Inhalants
Cardiac dysrhythmias
Copyright 2009 Seattle/King County EMS
Emergency Care
•
•
•
•
•
•
•
Maintain airway
Prepare for vomiting
Administer oxygen as needed
Assist ventilation
Monitor vital signs
Anticipate cardiac arrest
Treat for shock
Copyright 2009 Seattle/King County EMS
Summary
Drugs that produce a specific action in the
body by binding with cell receptors are
called agonists
Antagonists are drugs that cause a specific
action by binding with cell receptors and
blocking other agonists
Copyright 2009 Seattle/King County EMS
Summary, continued
Current trends
• Prescription pain medications
• Inhalants
• Club drugs such as Ecstasy
• Over-the-counter meds such as DXM
Copyright 2009 Seattle/King County EMS
Summary, continued
Opioids have a morphine-like action and
suppress the CNS
• Heroin
• Morphine
• Methadone
• Vicodin
• OxyContin
Copyright 2009 Seattle/King County EMS
Summary, continued
CNS stimulants increase heart rate, constrict
blood vessels and open air passages
• Cocaine
• Crack cocaine
• Methamphetamine
• Ecstasy
• Amphetamines
Copyright 2009 Seattle/King County EMS
Summary, continued
Depressants depress the CNS
• Barbiturates
• DMX
• Xanax
• Librium
• Valium
• Ativan
Copyright 2009 Seattle/King County EMS
Summary, continued
Hallucinogens cause an alteration in
perception, thought or mood
• LSD
• PCP
• Mescaline
• Peyote
• Psilocybin
Copyright 2009 Seattle/King County EMS
Summary, continued
Inhalants can produce a quick high that
resembles alcohol intoxication with initial
excitation, drowsiness, lightheadedness and
agitation
• Volatile solvents
• Aerosols
• Gases
Copyright 2009 Seattle/King County EMS
Summary, continued
Emergency care
• Maintain airway
• Prepare for vomiting
• Administer oxygen as needed
• Assist ventilation
• Monitor vital signs
• Anticipate cardiac arrest
• Treat for shock
Copyright 2009 Seattle/King County EMS