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

Your immediate treatment?

Scene SurveyABCsO2IVHistoryPhysical Exam

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

EMS Case Study

What may have happened?

Infection Toxic Metabolic Hypoxemia Neurologic Psychiatric

What happened to our patient?

• Rave party

• Returned home 6:30 AM

• Drinking

• Smoking

• GHB

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

Questions??