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Copyright 2009 Seattle/King County EMS
Overview of CBT 937 Street Medicine – Street
Drugs
Complete course available at www.emsonline.net
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IntroductionStreet Drugs • Trends in substance abuse are constantly
changing
• Change is even more rapidly today due to easily accessible information on the Internet
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Practical Skills
• Airway maintenance protection
• Assisted ventilation of patient with respiratory depression or respiratory arrest
To receive CBT or OTEP credit, you must perform the following practical skills:
A roundtable discussion is optional at the discretion of the training officer and evaluator. See skills checklist on EMS Online Downloads page.
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Termsagonist — 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.
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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.
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How Drugs Work
Drug-receptor interaction is like lock and key
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How Drugs Work, cont.
Drug molecules are carried by the circulatory system to receptor sites in body tissues
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How Drugs Work, cont.
It is here that the drug molecules bind with the cell receptor and produce an action
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Agonists
Drugs that produce a specific action by binding with a receptor are agonists
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Antagonists
Drugs that block the body's own substances from fitting into a cell’s receptors are antagonists
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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
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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
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Club Drugs
• Used by teenagers and young adults at nightclubs, bars, parties and raves.
• Ecstasy, GHB, Rohypnol, LSD and ketamine
Image credit: © iStockphoto
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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
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Alcohol
• Most commonly abused and potentially dangerous substance
• Depressant qualities• Causes severe CNS depression and
death
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Classes of Street Drugs
• Opioids• CNS stimulants• Depressants• Hallucinogens• Inhalants
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Opioids
• Morphine-like action in the body• Suppress CNS• Prescribed for pain relief
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Opioids, continued
• Heroin • Morphine • Methadone • Vicodin • OxyContin • Codeine • Demerol • Darvon • Dilaudid
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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
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CNS Stimulants, continued
• Cocaine • Crack cocaine • Methamphetamine • Ecstasy • Amphetamines • Ritalin • Dexedrine
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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
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Depressants, continued
• Barbiturates• DXM• Xanax• Librium• Valium• Ativan• Klonopin• Rohypnol• Ambien• GHB
Image credit: Public domain, Kodak Photodisc
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Hallucinogens
• Alter perception, thought or mood• Effects: anxiety, panic, irrational
behavior and psychosis • Can lead to injury to both the patient
and responders
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Hallucinogens, continued
• LSD• PCP• Ketamine• Mescaline• Peyote• Psilocybin mushrooms
Use extreme caution! Use extreme caution! Hallucinogens can cause unpredictable behavior.Hallucinogens can cause unpredictable behavior.
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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
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Inhalants, continued
Volatile solvents • Paint thinners • Paint removers • Degreasers • Dry-cleaning fluids • Gasoline • Lighter fluid • Correction fluid • Felt tip markers • Glue
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Inhalants, continued
Aerosols • Hair spray • Deodorant spray • Vegetable oil spray • Fabric protector spray • Spray paint
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Inhalants, continued
Gases • Nitrous oxide • Propane gas • Computer keyboard cleaner • Ether • Chloroform • Halothane • Butane • Propane • Whipped cream dispensers (nitrous oxide)
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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)
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Assessment
• Combining intoxicants is common • Mixed presentation of signs and
symptom • Often unpredictable and dangerous
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Street Drugs - Effects Opioids
• Shallow respirations
• Slow respiratory rate
• Hypotension • Pinpoint pupils • Lethargy • Respiratory arrest • Coma
CNS stimulants
• Hypertension • Tachycardia • Cardiac dysrhythmias • Hyperthermia • Sweaty skin • Dilated pupils • Seizures, rigidity • Agitation • Delusions • Paranoia
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Street Drugs - Effects,
continued Depressants
• Shallow respirations • Slow respiratory
rate • Hypotension • Lethargy, stupor • Slurred speech • Sedation • Coma
Hallucinogens
• Tachycardia • Tachypnea • Hypertension • Panic • Seizures • Visual illusions • Disorientation
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Street Drugs - Effects,
continued Inhalants
• Cardiac dysrhythmias
• Tingling • Numbness • Swollen membranes • Coma
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Immediate Threats to Life Opioids
CNS stimulants
Depressants
Hallucinogens
Inhalants
Respiratory depression/arrestHypotension
Cardiac dysrhythmiasSeizures
Decreased level of consciousnessRespiratory depression
Self-inflicted traumaViolence
Cardiac dysrhythmias
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Emergency Care
• Maintain airway • Prepare for vomiting • Administer oxygen as needed • Assist ventilation • Monitor vital signs • Anticipate cardiac arrest • Treat for shock
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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
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Summary, continued
Current trends• Prescription pain medications• Inhalants• Club drugs such as Ecstasy• Over-the-counter meds such as DXM
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Summary, continued
Opioids have a morphine-like action and suppress the CNS• Heroin• Morphine• Methadone• Vicodin• OxyContin
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Summary, continued
CNS stimulants increase heart rate, constrict blood vessels and open air passages • Cocaine• Crack cocaine• Methamphetamine• Ecstasy• Amphetamines
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Summary, continued
Depressants depress the CNS • Barbiturates• DMX• Xanax• Librium• Valium• Ativan
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Summary, continued
Hallucinogens cause an alteration in perception, thought or mood• LSD• PCP• Mescaline• Peyote• Psilocybin
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Summary, continued
Inhalants can produce a quick high that resembles alcohol intoxication with initial excitation, drowsiness, lightheadedness and agitation• Volatile solvents• Aerosols• Gases
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Summary, continued
Emergency care• Maintain airway • Prepare for vomiting • Administer oxygen as needed • Assist ventilation • Monitor vital signs • Anticipate cardiac arrest • Treat for shock