casestudystart

It is your first night shift of the tour. You have just finished an in-service and cleaned up the station when the tones go off. It is 10 p.m. and you are dispatched to a local bar for an unknown problem, unknown injuries. Police are responding as well.

You arrive on scene at the same time as the local police. Your crews are met by the bouncer who directs you to the women s washroom. Quite a crowd has gathered outside the facilities. Inside you observe a 30-year-old female lying left lateral recumbent on the floor. A female friend is also with her and is crying and making some commotion. A waitress is kneeling beside the female holding a cloth to her head.

The history you receive is rather vague and scattered. It appears the friend is somewhat intoxicated. She reports the patient was on her second or third drink and appeared to be getting very drunk, which is unusual for her. She left to go to the washroom and did not return. The friend went looking for her and found her “passed out” in a stall. She was able to get her friend to talk but she was not making any sense and the patient was unable to move at all.

The waitress reports the patient had been receiving drinks from a male patron but had only had two brown cows in total.

The patient is mumbling incoherently but not moving at all. Pulses are strong and regular at the neck and wrist. The patient is breathing, no adventitious lung sounds are noted, and there is decreased air entry to the bases. Her skin is cool, dry and pale. There are no obvious signs of trauma, no incontinence noted and no reports of seizure activity witnessed. The friend states the patient had vomited in the toilet. Pupils are equal and reactive to light. There is no history of past medical conditions and the friend states the patient takes birth control medications only.

The friend states the patient rarely drinks. They were having a “girls’ night out”, celebrating the patient’ s recent divorce. She reports the patient seemed to be feeling fine until approximately 30 minutes ago, when she started appearing intoxicated and left for the washroom. They have been in the bar for approximately two hours.

1. Your first treatment priority for this patient should be to ensure:

2. This patient is most likely under the influence of:

3. This patient should be given:

4. An Oral Pharyngeal Airway and ventilations via a BVM would be appropriate for this patient.

5. The most common recreational drug used in Canada other than alcohol is:

6. Cocaine is:

7. A patient who is “tweaking”:

8. Cocaine is:

9. If a patient tells you they have used a “deck of C”, they are referring to:

10. Cocaine is considered a:

11. The fastest way to experience a ‘cocaine high” is by:

12. “Freebasing” refers to:

13. The active ingredient in cannabis is:

14. Rohypnol may be referred to as:

15. Drug users most likely to pose a personal threat to EMS workers would be:

16. The E.C.G is:

17. Intravenous therapy for this patient should be avoided.

18. Flumazenil may be used to reverse the effects of:

19. Diazepam may be useful in treating patients on:

20. Rohypnol is:

21. Cocaine users are likely to experience:

22. Treatment for Rohypnol may include:

23. Treatment protocols for cannabis use may include:

24. Diazepam is contraindicated in cocaine users who are seizing.

25. Your service could increase effectiveness for this type of call by:

Special thanks to Detective Gordon Bannock of the Calgary Police Service for his help and great presentations on this topic.

M.P.H., Rohypnol Fact Sheet; Haight Ashbury Free Clinics: San Francisco CA 1996.

The answers to these questions are to industry standards and may not necessarily be correct according to local protocol If there is any discrepancy between these answers and local protocol, please follow the protocol for your area as set out by your Medical Director.

Heather MacKenzie-Carey is a paramedic with over 17 years EMS experience in Nova Scotia and Alberta. She has a Bachelor of Science Degree in Health Education from Dalhousie University, a diploma in Paramedicine from the Northern Alberta Institute of Technology, and a Certificate in Social Work from the University of Waterloo. Heather is an instructor for the Paramedic Program at the Southern Alberta Institute of Technology. She can be reached at: mailto:geomac@cadvision.comor http://www.turningpointgroup.com/

Canadian Emergency News and the author of this quiz grant permission for readers to copy it for personal and departmental educational purposes. All other reproduction and re-publication without written consent is prohibited.

This Article is reprinted by permission from the author (Heather MacKenzie-Carey) and the Canadian Emergency News.

Pulse	72 regular
Blood pressure	100/60
Respiration	12 shallow, equal air entry, no adventitious sounds
Skin	cool, dry, pale
Pupil Response	P.E.R.L.
Chemstrip	10.3 mmol/L
Pulse Oximeter Reading	96 per cent
Level of Consciousness	mumbles in response to loud voice or pain, no motor response
Age & Gender	30-year-old female
Weight	60 kg
E.C.G.

EMS Quiz

By Heather MacKenzie-Carey

1. Your first treatment priority for this patient should be to ensure:

2. This patient is most likely under the influence of:

3. This patient should be given:

4. An Oral Pharyngeal Airway and ventilations via a BVM would be appropriate for this patient.

5. The most common recreational drug used in Canada other than alcohol is:

6. Cocaine is:

7. A patient who is “tweaking”:

8. Cocaine is:

9. If a patient tells you they have used a “deck of C”, they are referring to:

10. Cocaine is considered a:

11. The fastest way to experience a ‘cocaine high” is by:

12. “Freebasing” refers to:

13. The active ingredient in cannabis is:

14. Rohypnol may be referred to as:

15. Drug users most likely to pose a personal threat to EMS workers would be:

16. The E.C.G is:

17. Intravenous therapy for this patient should be avoided.

18. Flumazenil may be used to reverse the effects of:

19. Diazepam may be useful in treating patients on:

20. Rohypnol is:

21. Cocaine users are likely to experience:

22. Treatment for Rohypnol may include:

23. Treatment protocols for cannabis use may include:

24. Diazepam is contraindicated in cocaine users who are seizing.

25. Your service could increase effectiveness for this type of call by:

Your comments are appreciated!

Just complete this form. Click on Submit when ready to send.

Your name:

Email address:

Any comments about the Case Study?

EMS Quiz

By Heather MacKenzie-Carey

1. Your first treatment priority for this patient should be to ensure: A. proper room ventilation B. bystanders are removed C. her drinks are analyzed D. airway control

2. This patient is most likely under the influence of: A. cocaine B. marijuana C. Rohypnol D. L.S.D.

3. This patient should be given: A. ipecac B. oral glucose C. D5OW D. oxygen E. A and D are correct

4. An Oral Pharyngeal Airway and ventilations via a BVM would be appropriate for this patient. A. True B. False

5. The most common recreational drug used in Canada other than alcohol is: A. marijuana B. crack C. cocaine D. L.S.D.

6. Cocaine is: A. water soluble B. ingested through the nostrils C. called crack if the hydrochloride is removed D. all of the above

7. A patient who is “tweaking”: A. is a cocaine user reaching the peak of the high B. is a heroin user "chasing the dragon" . C. may be unable to sit still, restless, anxious D. none of the above

8. Cocaine is: A. often found as a yellow powdery substance B. a dark brown liquid C. also called snow, blow, white or flake D. also called china white, black tar, peach, or red

9. If a patient tells you they have used a “deck of C”, they are referring to: A. 1 gram of drug B. approximately 10 uses C. cocaine D. all of the above

10. Cocaine is considered a: A. CNS stimulant B. CNS depressant C. hallucinogenic D. A and C are correct

11. The fastest way to experience a ‘cocaine high” is by: A. snorting B. cranking C. smoking D. intravenous injection

12. “Freebasing” refers to: A. removing hydrochloride from cocaine B. injecting cocaine C. smoking cocaine D. all of the above

13. The active ingredient in cannabis is: A. marijuana B. THC C. usually less concentrated in “home grown” forms D. B and C are correct

14. Rohypnol may be referred to as: A. rib, snow, flap B. white, up, number 3 C. ruffles, roach, roofies D. none of the above

15. Drug users most likely to pose a personal threat to EMS workers would be: A. cannabis B. Rohypnol C. crack D. hash

16. The E.C.G is:

17. Intravenous therapy for this patient should be avoided. A. True B. False

18. Flumazenil may be used to reverse the effects of: A. Rohypnol B. hash C. cocaine D. all of the above

19. Diazepam may be useful in treating patients on: A. cocaine/crack B. hash C. Rohypnol D. all of the above

20. Rohypnol is: A. a sedative B. a benzodiazepine C. stronger than diazepam D. all of the above

21. Cocaine users are likely to experience: A. elevated vital signs B. depressed vital signs C. neither A nor B D. both A and B are common

22. Treatment for Rohypnol may include: A. intubation B. gastric lavage C. activated charcoal D. all of the above

23. Treatment protocols for cannabis use may include: A. narcan B. Flumazenil C. activated charcoal D. all of the above E. none of the above

24. Diazepam is contraindicated in cocaine users who are seizing. A. True B. False

25. Your service could increase effectiveness for this type of call by: A. researching the local "drug scene". B. knowing local "drug haunts" C. developing protocols to deal with recreational drug use D. all of the above

Your comments are appreciated!

Just complete this form. Click on Submit when ready to send.

Your name:

Email address:

Any comments about the Case Study?

1. Your first treatment priority for this patient should be to ensure:

2. This patient is most likely under the influence of:

3. This patient should be given:

4. An Oral Pharyngeal Airway and ventilations via a BVM would be appropriate for this patient.

5. The most common recreational drug used in Canada other than alcohol is:

6. Cocaine is:

7. A patient who is “tweaking”:

8. Cocaine is:

9. If a patient tells you they have used a “deck of C”, they are referring to:

10. Cocaine is considered a:

11. The fastest way to experience a ‘cocaine high” is by:

12. “Freebasing” refers to:

13. The active ingredient in cannabis is:

14. Rohypnol may be referred to as:

15. Drug users most likely to pose a personal threat to EMS workers would be:

17. Intravenous therapy for this patient should be avoided.

18. Flumazenil may be used to reverse the effects of:

19. Diazepam may be useful in treating patients on:

20. Rohypnol is:

21. Cocaine users are likely to experience:

22. Treatment for Rohypnol may include:

23. Treatment protocols for cannabis use may include:

24. Diazepam is contraindicated in cocaine users who are seizing.

25. Your service could increase effectiveness for this type of call by: