1. Club Drugs The Prehospital Perspective Steven Katz, M.D., FACEP, EMT-P Associate Medical Director Palm Beach County Fire Rescue President National Paramedic Institute

2. EMS Case Study HPI  18 year-old girl returns from late- night rave  Sudden loss of consciousness while standing  Fall  Unresponsive

3. EMS Case Study Past Medical History: Unknown Medications: Unknown Allergies: None Social History: smokes when she’s drinking, alcohol on the weekends, no drugs

4. 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

5. EMS Case Study Your immediate treatment?  Scene Survey  ABCs  O2  IV  History  Physical Exam

6. EMS Case Study Physical Exam General: unresponsive, flaccid, lying in pool of vomit HEENT: unremarkable, no evidence of trauma Lungs: agonal respirations Cardiac: tachycardic, regular Abdomen: soft, no apparent tenderness Back: unremarkable Extremities: no evidence of trauma, no pedal edema Skin: dry, covered in vomit Neuro: unresponsive, nonverbal

7. EMS Case Study What may have happened?  Infection  Toxic  Metabolic  Hypoxemia  Neurologic  Psychiatric

8. What happened to our patient? Rave party Returned home 6:30 AM Drinking Smoking GHB

9. Clinical Features of GHB Euphoria, intoxication, aphrodisiac Respiratory depression Aggression, delirium, coma Pinpoint pupils Vomiting (50%) Seizures Bradycardia Myoclonic jerking movements

10. Street Names for GHB GHBGreivous Body Harm GBHGeorgia home boy GibNatural sleep-500 Gamma-OHGamma hydrate Liquid XOrganic Quallude Liquid ELiquid ecstasy Liquid GSomatomax SoapSalty water ScoopSodium oxybate Easy layCherry menth FantasyG-Riffick

11. Treatment for Altered Mental Status ABCs Complete vitals (temperature) Cervical spine precautions Scene Survey Continuous monitoring Transport Keep patient safe

12. Pearls of Wisdom GHB Patients may be comatose and may become suddenly alert and oriented. Intubated patients need to be well- secured.

13. 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

14. Methamphetamine Smoked, injected, or swallowed Initial rush, severe agitation, violent and dangerous behavior Stay awake for days Scene safety is very important

15. Ketamine Special K, K, Vitamin K, Fort Dodge Inhaled, injected, orally, smoked Increases blood pressure, heart rate, muscle tone, salivaton Brain-body dissociation

16. Rohypnol Roofies, roaches, ropies Fast-acting benzodiazepine Initial “date-rape drug”  Significant sedation  Amnesia

17. LSD Acid Potent psychactive agent “Blotter paper” “LSD Trip” Increased sympathetic response  Dilated pupils  Elevations in BP, pulse, temp  Seizure  Coma

18. PCP Angel dust Hallucinogen CNS stimulation or depression  Violent (35%)  Agitated (34%)  Bizarre behavior (29%)  Hypoglycemia (22%) SCENE SAFETY!!

19. Club Drugs Summary Scene Safety Airway Be aware for sudden changes Continuosly monitor Be thorough  Scene survey  History  Physical Exam  Talk to Bystanders

20. Questions??