Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Current street value about $200 - $350. What other than the obvious ABC's do you do for that. Is there enough Narcan on the truck or do you devirt to the morgue? Clinton Browning Lockhart Fire / Rescue Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Depends on the patient's tolerance. I'd put defib pads on, though. Mike Re: 8-ball Current street value about $200 - $350. What other than the obvious ABC's do you do for that. Is there enough Narcan on the truck or do you devirt to the morgue? Clinton Browning Lockhart Fire / Rescue Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Valium and NTG Christy Re: 8-ball > Current street value about $200 - $350. What other than the obvious ABC's do > you do for that. Is there enough Narcan on the truck or do you devirt to the > morgue? > > Clinton Browning > Lockhart Fire / Rescue > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Why?!? Is there *really* anything here you need to be treating in the field? Let's look... narcan is going to stop the actions of the opiates, leaving only the cocaine. All this is really going to do is cause excitability, possibly HTN and tachycardia. None of which are directly life-threatening, especially for someone who's used street drugs long enough to handle an eight-ball. Valium is only going to attempt to calm them, which isn't going to work well (imagine being tired and taking a lot of caffeine) as their mind will still be going a mile a minute. NTG? Why on earth would you want to use such a short-acting agent for cocaine-induced HTN in the ambulance? In most cases, hypertension simply doesn't need to be treated - the body self-regulates rather well (even when under the influence of street drugs)... and it's likely not going to be elevated enough to require treatment. Time is the definitive treatment here... Mike Re: 8-ball > Current street value about $200 - $350. What other than the obvious ABC's do > you do for that. Is there enough Narcan on the truck or do you devirt to the > morgue? > > Clinton Browning > Lockhart Fire / Rescue > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 And, let's discuss Narcan. " Enough narcan " ? What is this? Let's remember how Narcan works. It is *not* an antidote - it has *no* interaction with Heroin or other drugs. None. Naloxone/Narcan is an antagonist for all the receptors that opioids bind to, meaning that it will bind to a site and Herion can no longer bind and have an effect. Thus, the dose of narcan is based on the reaction of the patient - how much you give depends on the effect each dose has, effectively how many receptors it binds to and the effects of those receptors not being stimulated by Heroin anymore. The more receptors you wish/need to free up, the more Narcan you should give. But, the less you free up, the less traumatic to the overdose victim (even if they use street drugs, you really don't want to induce traumatic withdrawal and deal with not only a confused, combative patient but one experiencing painful and scary withdrawal without a " come-down " period). " Shock-injecting " loads of Narcan is probably not the best course of action in the back of an ambulance... My $.02. Mike PS - For more information, see http://www.moravek.net/ovisnosti/annintmed-01.htm Re: 8-ball > Current street value about $200 - $350. What other than the obvious ABC's do > you do for that. Is there enough Narcan on the truck or do you devirt to the > morgue? > > Clinton Browning > Lockhart Fire / Rescue > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Extensive cocaine abuse can and does lead to life-threatening arrhythmias, including sustained SVT (to the point of reduced cardiac output), VT and VF. This is not supposition, this is fact. Adenosine will not effectively convert cocaine-induced SVT. There is a different mechanism at work there. Cocaine abuse can also cause coronary artery spasm which can in turn cause decreased perfusion to the cardiac tissue. The NTG is not for hypertension here. So, when presented with the person who has admittedly taken 1/8 oz of cocaine that is experiencing chest pain, possibly SVT, you just are going to let time take its course? Bad idea. How do you know this person is a long time cocaine abuser? Many people bite off more than they can chew, especially if they are stupid enough to be taking cocaine in the first place. The benzodiazepine blunts the stimulatory effect of the cocaine on the nervous system, producing a net negative inotropic/chronotropic effect. The NTG helps relieve any coronary artery spasm that may be occurring. Is there some reason you would NOT do this? Refer to your ACLS text, you'll find it under Special Resuscitation Situations. Petty, EMT-P, ACLS-I Re: 8-ball > > > > Current street value about $200 - $350. What other than the obvious ABC's > do > > you do for that. Is there enough Narcan on the truck or do you devirt to > the > > morgue? > > > > Clinton Browning > > Lockhart Fire / Rescue > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 I am glad to hear that at least one person on here knows the correct way to manage these patients. I have seen alot of nothing but absurd comments and statements by people who " think " they know what they are talking about, but the fact remains what ACLS teaches regarding these " special situations " is the correct way to manage these patients. Thanks to Petty, EMT-P, ACLS-I for being the true professional in the bunch. As for Mike. I don't know you, but for an LP, you are pretty lacking in the basic knowledge you need to be familiar with regarding toxicological emergencies. I suggest you read up. Blum, EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 And one more response to Mike. Nobody advocates mass injecting Narcan to any patient. The purpose of Narcan is to help reverse life threatening problems in opiate overdoses (usually respiratory depression). This whole bit about crews dumping every last bit of Narcan in a Patient before arrival at the ER is a load of B.S. (Pardon my french). That is bad practice, and just wrong to do. However, giving Narcan and " titrating " the dose to maintain adequate respiratory function, or treat other life threatening side effects of the drugs is not only standard of care, but necessary. Withholding this from a patient in need is unethical, and unprofessional. Blum, EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 In a message dated 3/3/01 5:53:55 PM Central Standard Time, mreed911@... writes: > Once again, no offense Mike, but the statement wasn't " it should be done because ACLS says to, or because we can. " The statement was, that is the correct treatment and reasoning behind why and how we treat it. Just because the patient is having CP, doesn't mean that they are having a cocaine induced MI as well. If the patient is unfortunate enough to warrant an ambulance ride to the hospital secondary to the adverse effects that the cocaine has had on them, then they (in my experience) usually require som form of treatment. Nitroglycerine prevents the spasm if it hasn't already occurred, and prevents an MI. I once had a 13 year old kid die of a cocaine induced MI secondary to profound coronary artery spasm. The epam helps block the effects of the cocaine on the CNS. I am not advocating pushing drugs just because someone has a heart rate of 120, and is feeling a little hot, or is " wigging out. " However, not treating potentially life threatening or debilitating problems is neglecting your patient. I know there is no way to address the multitude of other substances that dealers " cut " their buyer's stashes with, as they are constantly changing. I know it happens, and I have seen the side effects of it. Most drugs on the street aren't pure anyway. And I don't dissagree with the fact that people sustain secondary injuries as a result of other " extra-curricular " activities that they engage in while under the influence of drugs. This is a given, and for every story you have, I can come up with a dozen more. We have all seen and heard of absurd things that have happened to people while using drugs. I work in a busy ICU now, and have worked in the field for a number of years. I have seen alot, and see more new stuff daily. The hospitals use the same treatment modalities as we do regarding overdose. In some cases, the specific problems are time limited, and warrant letting time take it's course....................however, most of the problems require intervention. This whole thing about 15 minute transport times brings me back to something else I once heard. 15 minutes isn't long for you, but try being the patient. The statemtent I heard was in regards to the implementation of RSI protocols. The arguement was " we are only 15 minutes from a hospital, why do we need this? " The response was, " it's 15 minutes to the hospital............it's just an airway! " The extra time spent obtaining a GOOD airway will save the patient in the long run. 15 minutes is too long to go without a secure airway. 15 minutes without treatment of a life threatening drug induced side effect, be it arrhythmia, CP, SOB, etc........is TOO LONG. Blum, EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Man, the price of an 8 ball has went up... Guess it must be because of the state of the economy........ If they have swallowed the crack whole, divert to morgue cause they probably ain't gonna make it anyway (just kidding- they will get there soon enough though). If it is a regular OD, just restrain the pt, monitor the ABC's, and let it run it's course, just take care of life threatning situations as needed. The ambulance is not a drug rehab or drying out center. Stabilize the pt and then let the ER or DTC (drug treatment center) They have a problem with smugglers smuggling in crack in condoms and other latex products (swallowing it), and when it ruptures, they are pretty much good as gone.... Funny thing is they can smoke it, snort it, and all that, but once they swallow their whole product, it has a tendency to mess up the internal organs beyond repair. I was reading on the internet where a pt had injected themselves with liquid coke (after he/she had melted the crack rock)- thinking it would lead to an immediate high, and for some reason certain body parts developed gangrene, fell off, (sp) and then he eventually died....... Jay > Current street value about $200 - $350. What other than the obvious ABC's do > you do for that. Is there enough Narcan on the truck or do you devirt to the > morgue? > > Clinton Browning > Lockhart Fire / Rescue Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 NTG administration is now permitted under the EMT-Basic NSC with medical director protocols and may be carried on BLS ambulances in Texas. Also albuterol and epi-pens. However, just because it's there doesn't necessarily mean it ought to be administered. I have no problem with it in typical chestpain of presumed cardiac origen when there is adequate BP and a good supportive history of the present illness. There is NOTHING standard, however, about 8-ball (speedball) patients, and we must always think in terms of multiple-drug syndromes. For example, I just today read about a guy who takes 900 mg of dextromethorphan (30 OTC pills) together with ETOH, marijuana, and morning glory seeds to achieve his " plateau. " Add some heroin into the recipe and whaddaya get? I would certainly want a 12 lead or at least a 3 lead with mcl1 and maybe mclr3 to look at before I did anything much with NTG. And I'd leave off the naloxone and simply bag/intubate the patient as required. Watch the oxymetry and keep it at 100%. Don't do anything to further screw up the patient pharmacologically until the blood studies come back, would be my thought, but whadda I know? GG E. Gandy, JD, LP EMS Professions Program Tyler Junior College Tyler, TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Comments inline... Mike Re: 8-ball > > > > Current street value about $200 - $350. What other than the obvious ABC's > do > > you do for that. Is there enough Narcan on the truck or do you devirt to > the > > morgue? > > > > Clinton Browning > > Lockhart Fire / Rescue > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Without getting into the ACLS/validity arguement (currently raging on another list, there are errors in the recent ACLS texts with regards to cardioversion for specific cardiac patients with low EF's), the fact remains: How many cocaine overdoses (the ORIGINAL question, NOT a cocaine-induced MI) *actually* need treatment in the back of an ambulance, other than basic monitoring? We do not carry medicines specifically designed to reverse the effects of cocaine, and the alternatives suggested may in fact interfere with later treatment. I think sometimes we get too wrapped up in a " can do " mentality and don't stop to think about continuing care. I'm not a passive medic. Ask folks I work with, I'm aggressive. But I'm aggressive when it meets the needs of the patient, not just because " I can be. " In almost a dozen years since I started riding as an observer through now as a paramedic, I've had *very* few patients whose primary disease or injury process was cocaine overdose alone. I've had MANY who mixed cocaine with other drugs (including marijuana, alcohol, heroin, organophosphates, you name it, much less what their coke was CUT with - ajax was a bad one). I've had many patients suffer trauma or medical illness (seizure, CNS symptoms, etc.) from cocaine. But I can honestly say that I've never, ever felt the need to treat the cocaine-only patients. Maybe it's because 15 minutes is a LONG transport time (we're close to hospitals). Maybe it's because I've usually had either hardcore addicts or expirimenting kids. Maybe I'm just lucky. But I resent the implication that " because the ACLS book says to " is a reason to perform a treatment. *Because a patient needs it* AND *because I understand what that treatment is doing* are the reasons to perform a treatment. I also resent being called " lacking in the basic knowledge " w.r.t. toxicology. What a toxicology book teaches is valuable, but remember, most of them don't write chapters on " Cocaine cut with Ajax, mixed with Heroin, chased by Tequilla and followed by rough anal sex (vagal stimulation). " And you think I'm kidding about the last part? A month ago, I had a patient dislocate his shoulder when his girlfriend applied a strap-on male genitalia device and proceed to perform anal sex on him, causing him to fall off the bed at a rather awkward angle. You *really do* see all kinds. Mike Re: 8-ball I am glad to hear that at least one person on here knows the correct way to manage these patients. I have seen alot of nothing but absurd comments and statements by people who " think " they know what they are talking about, but the fact remains what ACLS teaches regarding these " special situations " is the correct way to manage these patients. Thanks to Petty, EMT-P, ACLS-I for being the true professional in the bunch. As for Mike. I don't know you, but for an LP, you are pretty lacking in the basic knowledge you need to be familiar with regarding toxicological emergencies. I suggest you read up. Blum, EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Except that I've met MANY medics who think it's FUN to " strap em down and slam em with Narcan. " I wasn't making that up, or implying that anyone on this thread was doing it... but the mentality DOES exist (and it's got to be a GREAT way to get sued, eh Gene?). The thread originally said " don't have enough Narcan on the truck. " My thought mimics yours... how much do you really need? Titration to effect to reverse life-threatening conditions. We agree on this. Mike Re: 8-ball And one more response to Mike. Nobody advocates mass injecting Narcan to any patient. The purpose of Narcan is to help reverse life threatening problems in opiate overdoses (usually respiratory depression). This whole bit about crews dumping every last bit of Narcan in a Patient before arrival at the ER is a load of B.S. (Pardon my french). That is bad practice, and just wrong to do. However, giving Narcan and " titrating " the dose to maintain adequate respiratory function, or treat other life threatening side effects of the drugs is not only standard of care, but necessary. Withholding this from a patient in need is unethical, and unprofessional. Blum, EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Well Gene......to address the comment about, " it shouldn't be used just because it is there " ......I agree. I am not one to advocate (as I said earlier), doing things just because I (we) can, or using it just because I (we) have it. I am the last person to say you should just go out there randomly dosing NTG to CP patients as well. I assume when talking about these things (maybe wrongly so), that people on here realize the importance of pre-hospital 12-leads prior to giving NTG in CP patients. Unfortunately it hasn't been until recently that the importance of doing so has been focused on. Thinking back over the years that I have been doing this, and plenty of war stories I have heard from other medics, I have to wonder how many people actually had Right Ventricular MI's (unknown to us), that expired shortly after being given NTG or MS. We assumed that they must have been going to die anyway, when in actuality, it may have been our treatment (although not wrong at the time), that hastened these patients departure. It is just in the last few years that EMS has focused on proper treatment of these patients, the importance of " fluid loading " these patients, and the avoidance of using NTG and MS. Acute Coronary Syndromes is still a relatively new phrase to most people in EMS. I also understand that ACLS is just a guideline to follow, but it also sets a " standard of care " for us to follow. Changes take place all of the time, and there is always room for discussion on new ideas. ACLS changes every few years and the newest changes made in mid 2000 are possibly the most drastic ever. We have to change our way of thinking. EMS has become a more intellectual field, and it is true we aren't just the " trained monkeys " that EMS use to be. We must be able to think and reason for ourselves, and must truly understand the ramifications of our actions and treatment. Just because it says to do it in the protocol, doesn't mean to do it if you know it to be the wrong thing to do. I am a very open minded person and always listen to what people have to say, however, what was being said by Mike was essentially that time would fix the problems associated with these patient's illegal drug use, or overdose, and that we should just let the ER handle it. He also said that if they were going die, it's because they would have died anyway. I dissagree, and beleive that definitive care begins in the field. If a patient warrants care, they should receive it. Even if it is " preventive " care to keep them from developing more serious complications. You can always pick up a phone and run it by your Doc if you want, and I have rarely had one question my reasoning when asking to do something that will bennefit the patient. A short ambulance ride doesn't mean we don't need to treat these patients the same as someone who would require a longer transport. The standard of care should apply to ALL patients. And by standard of care, I don't mean formulas in a protocol book, or pages from ACLS, etc. I mean the most appropriate care for the patient should be rendered according to CURRENT accepted practices in medicine. Deviation is a must in some cases, and in those services where the MD allows his medics to deviate from protocol without consult, it means we need to know when it is right to do so, and be prepared to back our thoughts with solid medical reasoning, and that we use proper judgement. In the other situations where consult is required, it takes some of the weight off of the medic's shoulders. The medic should still be able to think through the medical reasoning behind what they are doing, and shouldn't just take orders blindly. If you do something that kills a patient, and the only rationalle you can give is " the Doc told me to do it, " then there is a problem. You must know when to question these orders and when to accept them. Medicine is an ever changing thing, and from one day to the next is never the same. As for waiting for blood studies to come back to begin certain treatment????? Most ER Doc's don't even wait for that, as it can cost precious time waiting. I agree that Narcan is truly over-used, however, I beleive that it is necessary for us to have and use, if done so very conservatively. Dr. Bledsoe made a valid point, and these are things that alot of EMS providers don't think about, and quite frankly think is funny. We won't know if someone OD'd on X, or Special K, or Cocaine, etc.....unless we know what to look for, have some experience treating these patients, and are judicious about obtaining as much information and history from the patient, friends, family, etc. We can't always count on this info, but it gives us some idea most of the time. We also can't count on purity of drugs, and that the person truly knew what they took. It is a best judgement call on our part, and that is all we can ask for. There is also the other thing that I remember from the first EMT class I took............ " First, do no harm! " Harm can come from withholding appropriate care, just as well as it can come from giving inappropriate care. Take care, Blum, EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Jana, The statment was that ACLS recommended that as treatment. The resoning is good behind it, and I have seen, as well as done it myself several times, both in the " street " , in the ER, and in the ICU. It as well as many things is always open to deviation, but it is a recommendation with good reasoning behind it. As I am sure you are well aware, the cause of most Cocaine realated MI is a result of the coronary artery spasm, not the over work of the heart. The NTG helps prevent the spasm, and helps reverse it if it has occurred. An earlier comment was made about using NTG because it was so short acting........That is the beauty of NTG, it dissipates quickly, and hence is very easy to control. Most other drugs used to control HTN are much longer acting, such as lopressor, and labetalol......Nipride is a bit extreme, especially since it may interract with other drugs, however, NTG, is relatively benign if used CORRECTLY. i.e. 12-lead, patient not having used sildenafil, etc. Sildenafil is interestingly becoming a " rave " drug........I am waiting for the rash of people who have adverse reactions, or priapism to hit the 911 circuit, but as of yet have not seen one. Blum, EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 If a paramedic in my system found this fun and tried it, they would find themselves in the ED taking care of the patient. There is nothing worse than a heroin addict in withdrawl. The paramedic would enjoy emptying the 15-20 pans of foul-smelling diarrhea the patient would present us with, along with 5 emesis basins full of snot, 8 basins of vomitus containing streaks of blood from microscopic Mallory-Weiss tears, the constant sneezing, constant jerking by the patient, the tacycardia, cough, hallucinations, and so on. The paramedic will them inform the patient that " federal law prevents us from administering narcotics to a known addict except for a medical condition " each time the patient cried, moaned, and bitched. I'll bet the next time the paramedic would pass on having " fun. " . Bledsoe, DO, FACEP EMS Medical Director Re: 8-ball > > > And one more response to Mike. Nobody advocates mass injecting Narcan to any > patient. The purpose of Narcan is to help reverse life threatening problems > in opiate overdoses (usually respiratory depression). This whole bit about > crews dumping every last bit of Narcan in a Patient before arrival at the ER > is a load of B.S. (Pardon my french). That is bad practice, and just wrong > to do. However, giving Narcan and " titrating " the dose to maintain adequate > respiratory function, or treat other life threatening side effects of the > drugs is not only standard of care, but necessary. Withholding this from a > patient in need is unethical, and unprofessional. > > Blum, EMT-P > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 To clarify myself to Christy & , ..... why else would you use Narcan except if extreme conditions are present?? I did not mean to imply so, if I did. And as for RVMI not being a contraindication for NTG, you are wrong. If you give NTG, or Morphine, you will most likely kill the patient, unless you FLUID LOAD the patient, sometimes with several liters of fluid, before administering the drug. It takes out what little ability the heart has left to maintain it's own pressure. RVMI is highly understood by most, and is very touchy. The definitive treatment for RVMI in the pre-hospital setting is fluid, and lots of it, unless they present in failure (CHF). Careful monitoring will not help as the effect is almost instantaneous....the blood pressure will cease to exist. The only thing you can hope for is that if you do give it with findings of RVMI, is that it is in fact actually Prinzmetal's Angina. If it is, it can present with findings on the 12-lead that mimic an RVMI! , but without the side effects i f NTG or MS is administered. Any finding indicating possible Inferior MI should be suspect for RVMI, and V4R should be checked to confirm before NTG or MS administration. Hence, why this is such a big topic right now with basics and intermediates giving NTG. The current school of thought is swinging towards teaching them to read a 12lead so they can rule it out before they give NTG. Blum, EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Are you talking street value of cocaine or meth? That sounds about like meth, I believe that coke is even higher, but maybe not. Anyway, over a 24 hour period, that's not really all that much cocaine, now meth, that would be quite a bit for one person. We just watched this boy (he was 21, a " boy " to me!) and sent him home when his heart rate and bp came down. He was already conscious and alert, so we gave some Narcan, but it's so short acting that the doc decided to not give any more unless he began showing worse symptoms. Now, had he done that in a short period of time, then his outcome would probably have been different. Or if he'd done meth, especially that much in that period of time, it would have been a different outcome. But, we just monitored him, and if I recall correctly, this has been several years ago, we ended up sending him home with parents after a few hours. Take care and go safely! Jana Re: 8-ball > Current street value about $200 - $350. What other than the obvious ABC's do > you do for that. Is there enough Narcan on the truck or do you devirt to the > morgue? > > Clinton Browning > Lockhart Fire / Rescue > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Christy, I've seen the valium given, but the NTG? We've never done that in the ER. I can see possibilities because the NTG would dilate the blood vessels, but we've never given it. Is that standard on your service? I'll have to check with the docs in my ER. Take care and go safely! Jana Re: 8-ball > > > > Current street value about $200 - $350. What other than the obvious ABC's > do > > you do for that. Is there enough Narcan on the truck or do you devirt to > the > > morgue? > > > > Clinton Browning > > Lockhart Fire / Rescue > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 Gene, I hope I'm not misinterpreting your post, but I've gotten the feeling that in your post and others' that we are saying that an 8ball is a mixture of different drugs. It is not. It is a measure of powdered drugs such as cocaine and meth. Now, you say " 8ball (speedball) " and those are 2 different things. 8ball is a measure - 3.75 grams and speedball is a mixture of drugs. Speedball can be any mixture, but is commonly meth and cocaine mixed. Just wanted to clarify because this has gone way out there from my original post. Not flaming or getting on anyone - actually it's been kinda interesting, but wanted to clarify that 8ball and speedball are 2 completely different things. Take care and go safely! Jana Re: 8-ball > NTG administration is now permitted under the EMT-Basic NSC with medical > director protocols and may be carried on BLS ambulances in Texas. Also > albuterol and epi-pens. However, just because it's there doesn't necessarily > mean it ought to be administered. > > I have no problem with it in typical chestpain of presumed cardiac origen > when there is adequate BP and a good supportive history of the present > illness. > > There is NOTHING standard, however, about 8-ball (speedball) patients, and we > must always think in terms of multiple-drug syndromes. For example, I just > today read about a guy who takes 900 mg of dextromethorphan (30 OTC pills) > together with ETOH, marijuana, and morning glory seeds to achieve his > " plateau. " Add some heroin into the recipe and whaddaya get? > > I would certainly want a 12 lead or at least a 3 lead with mcl1 and maybe > mclr3 to look at before I did anything much with NTG. And I'd leave off the > naloxone and simply bag/intubate the patient as required. Watch the oxymetry > and keep it at 100%. Don't do anything to further screw up the patient > pharmacologically until the blood studies come back, would be my thought, but > whadda I know? > > GG > > E. Gandy, JD, LP > EMS Professions Program > Tyler Junior College > Tyler, TX > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 , Thanks so much for the information! It's just not something I've seen used, but maybe I just haven't seen the right pt. for it to be used. So far, I've been lucky not to have seen many ODs in the ER where I work now. The one before, yes, we saw many, but luckily all but one I saw survived. Now, I didn't always know what the treatment was because if it wasn't my pt. with a total of 32 beds, I often did not know the exact treatment. Now, I'm in a considerably smaller ER, so less ODs and more knowledge of treatment. Thanks again for the explanation. Thought it sounded plausible, but just hadn't used it or seen it used! Take care and go safely! Still learnin' Jana! Re: 8-ball > Jana, > > The statment was that ACLS recommended that as treatment. The > resoning is good behind it, and I have seen, as well as done it myself > several times, both in the " street " , in the ER, and in the ICU. It as well > as many things is always open to deviation, but it is a recommendation with > good reasoning behind it. As I am sure you are well aware, the cause of most > Cocaine realated MI is a result of the coronary artery spasm, not the over > work of the heart. The NTG helps prevent the spasm, and helps reverse it if > it has occurred. An earlier comment was made about using NTG because it was > so short acting........That is the beauty of NTG, it dissipates quickly, and > hence is very easy to control. Most other drugs used to control HTN are much > longer acting, such as lopressor, and labetalol......Nipride is a bit > extreme, especially since it may interract with other drugs, however, NTG, is > relatively benign if used CORRECTLY. i.e. 12-lead, patient not having used > sildenafil, etc. Sildenafil is interestingly becoming a " rave " drug........I > am waiting for the rash of people who have adverse reactions, or priapism to > hit the 911 circuit, but as of yet have not seen one. > > Blum, EMT-P > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2001 Report Share Posted March 3, 2001 The NTG would only be given if there are indications for it. I was not necessarily specific about what does or does not constitute indications, so I suppose I should have been. For the patient COMPLAINING OF CHEST PAIN, we supply oxygen. We administer NTG if the BP is sufficient. 12-lead EKG is standard practice in our service. It is a fallacy to assume the BP is to control hypertension in a chest pain patient - that is not the primary motivation and I never stated that it was. The motivation is to dilate the coronary vasculature in an effort to increase perfusion to the cardiac tissue. For malignant hypertension we have the option of labatelol. There are other options available for the management of the chest pain patient, but that would progress beyond the scope of this discussion. Regardless of the etiology, and with the exception of pleuritic or muscular chest-wall type chest pain, cardiac chest pain is almost exclusively due to inadequate oxygenation of the myocardium. I know of no more efficient means to increase that oxygenation than by increasing perfusion and providing supplemental oxygen. In the young and otherwise healthy individual with a low probability of underlying cardiac stenosis or disease, otherwise normo- or hypertensive, it would stand to reason that coronary arterial spasm is the culprit. In cocaine intoxication, it is not unusual - in fact, it is quite common - that the patient is experiencing significant tachycardia, chest pain or pressure, oxygen hunger, anxiety, so forth. In fact, that is generally the reason the ambulance is called in the first place; either a relatively new user has experienced unexpected untoward symptoms, or bystanders have discovered the patient and have become alarmed due to the signs/symptoms manifested. Bottom line is that if the ambulance has been called, the patient is generally symptomatic. The use of benzodiazepines in tachycardia associated with cocaine intoxication is not new science. It has been proven time and again. The use of NTG, while possibly not considered standard, only makes sense when and only when the criteria for that administration exists. Are we suggesting that we actually withhold NTG from a symptomatic patient with chest pain, without other contraindications? (By the way, a right-sided infarct is not a contraindication to the use of nitroglycerin; it is a signal to carefully monitor the blood pressure and ensure that the patient does not become hypotensive as a result of the treatment.) Naloxone has no place in the management of cocaine intoxication. It has little place in the field management of opiate intoxication, unless extreme conditions are present. & Christy Petty, EMT-P's Re: 8-ball > > > > > > > Current street value about $200 - $350. What other than the obvious > ABC's > > do > > > you do for that. Is there enough Narcan on the truck or do you devirt to > > the > > > morgue? > > > > > > Clinton Browning > > > Lockhart Fire / Rescue > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2001 Report Share Posted March 4, 2001 Thanks for the clarification. I find that there are varying definitions of these things depending upon what part of the country you're in. Somebody ought to undertake to do a comprehensive dictionary of street terms. There are many lists, but Goldfrank, Director of the New York Poison Control Center and Director of Emergency Services at Belleview Hospital in New York City defines " speedball " as heroin/cocaine mixture. That's what I've always heard it referred to as. Also Tintinalli's 4th ed. of Emergency Medicine refers to speedball as heroin/cocaine. The term 8Ball is generally regarded as an eighth of an ounce, or roughly 3.54 grams if you use avoirdupois ounces or 3.8 if you use troy ounces. Who knows what the street dealers use. Also, who knows how the stuff is cut? 8Ball, as I understand it can refer to any poweder, whether it be amphetamines, powdered cocaine, or something else. Gene E. Gandy, JD, LP EMS Professions Program Tyler Junior College Tyler, TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2001 Report Share Posted March 4, 2001 Yes, you knew, I was just reading the other post wrong. So sorry, should have know that you knew what you were talking about. Hope I didn't offend you Gene! Still friends? Thanks! Jana Re: 8-ball > Thanks for the clarification. I find that there are varying definitions of > these things depending upon what part of the country you're in. Somebody > ought to undertake to do a comprehensive dictionary of street terms. There > are many lists, but Goldfrank, Director of the New York Poison Control Center > and Director of Emergency Services at Belleview Hospital in New York City > defines " speedball " as heroin/cocaine mixture. That's what I've always heard > it referred to as. Also Tintinalli's 4th ed. of Emergency Medicine refers to > speedball as heroin/cocaine. > > The term 8Ball is generally regarded as an eighth of an ounce, or roughly > 3.54 grams if you use avoirdupois ounces or 3.8 if you use troy ounces. Who > knows what the street dealers use. Also, who knows how the stuff is cut? > 8Ball, as I understand it can refer to any poweder, whether it be > amphetamines, powdered cocaine, or something else. > > Gene > > > E. Gandy, JD, LP > EMS Professions Program > Tyler Junior College > Tyler, TX > > > Quote Link to comment Share on other sites More sharing options...
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