Case EMS GBM Minutes
11/1/11
General Information about CaseEMS
 Minors cannot refuse treatment without parent on site
 Protocol states minors must receive treatment – cannot sign refusal forms
 Medical control cannot tell you let you them refuse
 Do not release patients to the care of dorm mates
 Speak to attending not residents when talking to medical control
 If minors keep refusing can call police or medical control
 Think about where you are leaving patients – take them to a safe place before
leaving
 Think while on call
Tricia Martin, Guest Lecturer
 Instructor at Cleveland Clinic Paramedic center
 What is out there?? – Street drugs
o Stimulants, sleeping meds, pain meds, sedatives are all used on college
campuses
 All prescriptions so all legal
 Ritalin is big in high school and college
 Powdered cocaine
o Highly available
o Cut with baby aspirin, formula, laxative, caffeine, hallucinogens, inositol,
meth, Orajel, PCP, diltiazem, caffeine, lidocaine
o Increases heart rate, blood pressure usually but the other things usually
decrease HR and BP so not normal symptoms
o Known as blow, girl, white girl, snow
o 35% of all drug related deaths is cocaine
o Common routes of use include snorting, injection, smoked
o Younger users tend to speedball
 Inject cocaine and heroin
o Older users tend to snort and share needles (HIV)
o Heroin users use cocaine to come back up
o If people drink too much alcohol, may use cocaine to sober up
 Mixing cocaine and alcohol creates another drug
o Hole in mouth and death can occur
o Cocaine has medicinal purposes (to restrict blood vessels)
o Expensive
o Constriction of blood vessels, dilated pupils, increased temperature, HR
and BP up, hyper-alertness, lack of fatigue, panic, talkative, fast speech,
runny nose, seizures, white powder, rolled dollar bills
 Crack Cocaine
o Highly available
o Cut with diltiazem, lidocaine, caffeine, baking soda, baby formua, heroin,
PCP
o Rock, hard
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Common route is smoing
Used with alcohol, heroin, marijuana, sedatives
Meth may be mixed with crack to hide poor quality of drug
Primo, loveboat, wet: crack and marijuana
Pupils will be huge, hyperactivity, high temperature, sweating, sensitivity
to light and sound, sexual dysfunction, dramatic mood changes, extreme
self confidence, anger, despression, paranoid, suicide thinking, intense
arguing, no food in house, highly skilled at covering up, denies and lies,
burns
o Similar symptoms to powdered cocaine
o No demographic centralization
Heroin
o Highly available
o Fastest growing drug problem in region
o Common type is brown powder
o White powder (baby formula) is available, while black tar heroin (baking
soda) is rare
o Most common drug present in drug-related deaths
o Increase in prescription opioid use and heroin use
o Cut with diltiazem, cocaine, fentanyl (100x stronger than morphine),
paregoric (antidiarrheal agent), prescription opioids, sleeping pills, vitamin
B, procainamide, lidocaine
o Known as boy, dog food, brown, H, horse, smack, stamps, tickets, Mac 22
(if cut with fentanyl)
o Injection is preferred route, with snorting being second most popular
method
o Gaining popularity among high school teens and young adults
o Overdose more frequent with heroin than other drugs
o Shortness of breath, dry mouth, constricted pupils, sudden changes in
behavior, disorientation, cycles of hyper alertness followed by nodding off
o One ounce = $3600.00 (Each bag is 1/10 gram = $10.00)
Prescription Opioids
o Highly available
o Obtained through dealers, family, friends, medical prescriptions from
ED’s, pain clinics and certain physicians
o Oral ingestion is most preferred route, with snorting following
o Commonly present in drug-related death
o Most common include OxyContin OP, Percocet and Vicodin
o OxyContin OC has been discontinued and is more difficult to obtain
o Opana and methadone (helps get off heroine) are up and coming opioids
that are gaining popularity
o Known as pharmies, skittles, willies, old couches, chairs, tall ones
o Priced to sell by pill, patch, wafer, mg
o Most often used in combination with alcohol, crack, marijuana, sedativehypnotics
o Hard to control because they are legal to obtain
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o Overdose on Tylenol will result in 50/50 chance of liver transplant within
3 days
o Constipation, depression, low BP, decreased respiration rate, confusion
Suboxone
o Acquired from doctors, family, friends
o Usually limited to heroin users who are trying to avoid withdrawl
symptoms when heroin cannot be obtained
o Is used in combination with crack and powedered cocaine, marijuana, and
sedative-hypnotics
o Sublingual
o Cold, clammy, coma, confusion, dizziness, weakness, fainting,
hypotension, unconscious
Sedative-Hypnotics
o Widely available
o Benzodiazepines, barbiturates, muscle relaxants, rohypnol, GHB, valium
o Usually obtained from family, friends, medical prescriptions
o Common routes are orally and snorting
o Downers, willies, blue guys, V’s, xani’s
o Priced per particular pill or milligram
o Often used in combination with alcohol, crack, heroin, and marijuana to
either come down from other drugs or boost the cocaine and heroin.
o Drowsiness, confusion, unsteady gait, poor judgment, involuntary and
rapid movement of the eyeball (stagmis)
Marijuana
o Highly available
o Common route is smoking
o Different quality:
 Regular weed
 Hydroponically grown
o Commonly known as bottom browns, dank dirt (low), b-sters, commercial,
middies, merch (regular), Bobby brosn, diesel, ice princess (high grade)
o Pound = $1000.00
o Reduces motivation, paranoia, sleep eyes, dry mouth, throat cancer, lung
cancer, increases HR, increases appetite, increases BP, wakens immune
system, decreases sex drive, abnormal menstrual cycles
o If upset, angry, sick then marijuana is laced with things
Methamphetamine
o Rare in urban, highly available in rural area
o Most common route is snorting and smoking
o Known as glass, ice
o Shake n bake method of prepping, includes common household chms,
ammonium nitrate, pseudoephedrine
 Mix in 2 L bottle and cook
o Disturbed sleep, excessive excitation, talking, panic, anxiousness,
nervousness, moodiness, false sense of confidence, delusions
Ecstasy
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Highly available
Dance clubs, night clubs, strip clubs
Typically used by teens to 40 year olds
Known as X, skittles
Prices for stakcs (doses)
Methacathinone and bath salts used to cut
Hyper-alertness, sweating, dry mouth, increased HR, fatigue, jawclenching, hyperthermia, agitation, increased emotional responses
Prescription stimulants
o Moderately available
o Not normally encountered with a drug dealer
o Popular among high school and college
o May be ingested, crushed, snorted, injected, or dissolved
o Adderall, desoxyn, Ritalin
o Weight loss, agitation, irritability, insomnia, high BP, irregular HP
Bath Salts
o Highly available
o Sold legally in drug stores, convenience marts, head shops
o Common routes are smoking and snorting
o Users tend to be young adults and teens
o Hallucinogenic effects, anxiety, paranooia, delusions, insomnia, vivid
nightmares, suicidal thoughts, high BP, severe stomach pains, vomiting,
seizures
K2
o Unregulated mixture of dried herbs, legal, purported to give a high similar
to marijuana and believed to be natural and therefore safe
o Herbal and spice plant products but it is sprayed with a potent
psychotropic drug and likely contaminated with an unknown toxic
substance that is causing many adverse effect