Prehospital Academy Lesson 27.3
Toxicology: Hypnotics, Sedatives, and Recreational Drugs
This lesson explores the effects and management of various hypnotics, sedatives, and recreational drugs, providing essential information for advanced EMS providers to identify and treat patients experiencing toxicity from these substances.
Marijuana and Cannabis Compounds
Derived from Cannabis sativa, these compounds contain Delta-9-tetrahydrocannabinol (THC) as their primary psychoactive ingredient. Consumption methods include smoking, ingestion, and vaporization.
Short-term effects: Mild tachycardia, palpitations, altered balance and coordination, increased appetite, euphoria, relaxation, altered perception of time.
Adverse effects: Anxiety, paranoia, panic attacks, impaired memory and judgment.
Prehospital assessment/management:
Generally not life-threatening.
Provide emotional support and reassurance for anxiety or paranoia.
Limit sensory input (dim lights, quiet environment) to reduce overstimulation.
Supportive care: monitor ABCs, oxygen if hypoxic.
For severe anxiety with cardiovascular implications, advanced providers may consider benzodiazepines (per protocol).
Hallucinogens
These substances distort perception, thought, and mood. The user's experience is influenced by prior drug experience, dose, expectations, and social setting. They can be synthetic (e.g., LSD) or naturally occurring (e.g., psilocybin mushrooms).
LSD (Lysergic Acid Diethylamide):
Physiological effects: Mild tachycardia, palpitations, mydriasis (dilated pupils).
Psychological effects: Intense visual and auditory hallucinations, altered thought processes, emotional lability.
Prehospital management: Largely supportive. Reduce sensory input. Provide calm, reassuring environment. Protect patient from self-harm or environmental hazards.
PCP (Phencyclidine)
A dissociative anesthetic with hallucinogenic properties, typically smoked or snorted.
Effects: Sense of invincibility, extraordinary strength, lack of pain awareness, aggression, bizarre behavior, nystagmus (involuntary eye movement).
Dangers: Leads to significant self-inflicted trauma due to altered pain perception and perceived strength. Users can become extremely combative and violent.
Prehospital management:
Patient and Provider Safety: Paramount. Requires adequate personnel for safe restraint if necessary (law enforcement assistance often required).
ABCs: Manage airway, breathing, circulation. Oxygen if hypoxic.
Paramedic interventions: Intramuscular sedatives (e.g., benzodiazepines) for combative/aggressive patients (per protocol).
Transport: Expedite transport to a facility for definitive care, ensuring patient and crew safety throughout.
Ketamine
Used pharmacologically as an anesthetic and analgesic, but also recreationally.
Low doses: Mild inebriation, euphoria, increased sociability.
Higher doses ("K-hole"): Profound nausea, dysphoria, visual and auditory hallucinations, out-of-body experiences, "entering another reality," dyskinesia (difficulty moving).
Prehospital management:
Safety: Secure patient, manage ABCs.
Oxygen: If hypoxic.
IV access: Establish vascular access for advanced providers.
Supportive care: Protect from self-harm, monitor vital signs.
Critical Thinking Questions
You are called to a party for a young adult experiencing extreme paranoia and agitation after ingesting cannabis edibles. What are your immediate prehospital management priorities, and what non-pharmacological interventions might you employ?
A patient presents with a history of PCP use, exhibiting extreme strength, lack of pain sensation, and combative behavior. What are the key safety concerns for both the patient and EMS providers, and what advanced interventions might be considered?
Describe the potential dangers associated with ketamine toxicity at higher recreational doses, and outline supportive care measures an advanced EMT or paramedic might implement.
Discuss the importance of a thorough patient history and scene assessment when dealing with altered mental status potentially related to recreational drug use.
In a patient experiencing hallucinogenic effects, why is minimizing sensory input a beneficial intervention, and what are some practical ways to achieve this in the prehospital setting?