As you and the police enter the building, it appears a party has been in progress, although the crowd has thinned since the of police. As you enter the apartment, you note the air is thick with smoke. A very calm, relaxed female greets you at the door and reports her friend is sick and needs help.

The living room area is littered with beer bottles and ash trays. There are a number of candles around the room, many of them lit. On the coffee table you notice a large candle and a couple of spoons. There are also a few cigarette filters lying in one spoon.

The patient is lying supine on the couch and does not appear to notice your arrival. She appears to be approximately 20 years old. The friend reports the patient was “partying hard” and appeared to have passed out. A couple of hours later they are unable to rouse her and someone suggested they should phone for an ambulance.

Your primary survey reveals snoring respirations. The patient’s breathing is shallow at a rate of eight perminute.  Pulses are present at the neck and wrist but are slow, regular and weak - especially at the radial site. Lung soundsare equal, bilaterally, diminished in the bases, with no adventitious sounds. The patient withdraws slightly to painful stimuli. Pupilsare dilated and slow to respond. No trauma is evident and the secondary survey is unremarkable. No track marks areevident.

When the police officers leave the area, the friend reports, the patient does not do intravenous drugs and does not usually do any “real” drugs. Tonight some people were “chasing  the dragon” and the friend suspects the patient might have for done so as well. She has been depressed over her parents  divorce and acting somewhat unusual. The friend reports the  patient has no past medical history, no medications other than birth control pills, and no allergies. She states the arrival  patient last ate around 8 p.m. when they had some pizza and a beer. The friend believes the patient only had two beers all  night and no other alcohol.

Pulse	6O b/minute, regular, weak
Blood pressure	94/50
Respiration	8 shallow
Skin	warm, dry, pink
Pupil Response	equal, sluggish, dilated
Chemstrip	9mmol/L
Level of consciousness	withdraws from pain
Pulse Oximetry	97 per cent
E.C.G.

1. Given the friend’s report and patient presentation, this patient has probably taken: A. LSD B. cocaine C. heroin D. methamphetamine    

2. Chasing the dragon refers to: A.  smoking heroin B.  injecting heroin C.  injecting cocaine  D.  using methamphetamine    

3. Your first treatment for his patient should be: A.  remove from the scene  B.  position airway  C.  initiate an intravenous D.  load and go     

4. The patient’ s presentation and vital signs indicate: A.  CNS depression B.  CNS stimulation C.  head injury D.  none of the above    

5. The cigarette filters, spoons and candles should alert you to possible: A. satanic rituals B. intravenous drug use C.  LSD use  D. all of the above  

6. This patient should be considered: A.  stay and stabilize B.  load and go 

7. Death from heroin use/overdose: A. has never been reported B. is known as hot capping C. occurs primarily when smoking heroin D. B and C are correct    

8. Withdrawal from heroin may cause: A. violent behavior B. flu like symptoms C. muscle spasms  D. all of the above    

9. This patient’s respirations should be managed by: A. positioning only  B. positioning and oxygen C. ventilations with BVM D. none of the above    

10. The effects of methamphetamine include: A. irritability B. anxiety C. hallucinations D.  all of the above    

11. Amphetamines: A. increase heart rate B. are known as speed C. suppress appetite D. all of the above    

12. Magic mushrooms are: A. called acid B. ingested C. melted and ingested D. smoked    

13. Ectasy users will most likely pose a problem for EMS workers: A. when coming down from the high B. when at the height of the high C. when not using the drug D. none of the above    

14. The effects of Ectasy: A.   include euphoria B.    last for approximately 36 hours C.    include personality changes D.   all of the above    

15. The affects of inhalents: A.   have a long duration B.    are similar to cocaine C.    have a sudden onset D.   all of the above     

16. The E.C.G of the patient in the scenario is: 

17. This rhythm should be treated with: A.   atropine B.    pacing C.    epinephrine D.   none of the above 

18. Respiratory management for this patient would include: A.   intubation B. narcan C. ventilation D. all of the above E.    A and C only    

19. This patient should have an intravenous running as: A. T.K.V.O. B. 20 mi/kg fluid challenge C. 250 ml fluid bolus D. 125 ml/hour    

20. Treatment for inhalent use includes: A.   ipecac B.    proper ventilation C.    narcan D.   diazepam    

21. Inhalent users may experience: A.   decreased L.O.C. B.    increased heart rate C.    CNS stimulation D. any of the above    

22. Long term effects of methamphetamine include: A.   kidney disorders B.    personality changes C.    stroke D.   all of the above E.    none of the above     

23. Heroin is known as: A.   crank B.    MDMA C.    skag D.   all of the above    

24. The most important thing to check for in drug abuse calls is: A.   airway B. personal safety C. level of consciousness D. circulation    

25. You could increase your effectiveness on drug calls by: A.   being aware of drug lingo B.    looking for drug para­phernalia C.    knowing community support agencies and services in your area D.   all of the above  

References;

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

National Clearinghouse on Alcohol and Drug Information

Alberta Alcohol and Drug Abuse Commission 1993. ABCs of Talwin & Ritalin

Applied Medical Informatics Inc., 1997. Health Answers

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: geomac@cadvision.com or 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. It originally appeared in the June - July 1998 issue (volume 21, number 3).