Poison Center OverviewK2 and Bath Salts

New Drugs of AbuseSanford Poison Center - Amy Marsh

South Dakota Monthly EMS training ProgramSouth Dakota Department of Public Safety – Office of

EMSJanuary 2012 – Medical Emergencies

OBJECTIVES• Upon completion of this presentation, the

student will be able to identify the four routes of exposures.

• Upon completion of this presentation, the student will be to identify the phone number for the Poison Center- 800-222-1222

• Upon completion of the presentation, the student will be define the two new drugs of abuse – K2(Spice) and Bath Salts.

Routes of Exposure

• Ingestion• Inhalation• Injection • Absorption

Poisoning by Ingestion

• Definition - Item is swallowed or taken in by mouth• Most common are medications and household

cleaners• Assessment clues include open bottles, stained

fingers, lips or tongue, or chewed leaves on a plant. • Ingestion is normally a slow absorption unless it is

caustic and may cause burns to the mouth and lips.

Ingestion Poison Emergency Care

• Try to identify product ingested• Treat any life threatening emergencies such as

breathing difficulties• Contact Poison Center – 800-222-1222 for

treatment protocol

Poisoning by Inhalation

• Definition – Patient has breathed in toxin. • Most common is Carbon Monoxide• Ensure your safety and call for special

resources to remove patient if they are still in the toxic environment.

• Depending on the toxin can rapidly or slowly enter the body.

Inhalation Poison Emergency Care

• Remove patient from toxic environment. This needs to be done by local Haz-Mat team or those specifically trained.

• Administer high concentration of Oxygen• Contact Poison Center – 800-222-1222 for

treatment protocol

Poisoning by Injection

• Definition – toxin enters the body through a puncture caused by a needle, a bite or a sting.

• Most commonly associated with drugs of abuse such as heroin or cocaine.

• Poison spiders and snakes also cause an injection poisoning.

• Rapidly absorbed into the body.

Injection Poison Emergency Care

• Ensure scene safety• Contact Poison Center – 800-222-1222 for

treatment protocol

Poison by Absorption

• Definition – toxin absorbed through the skin • Most common toxin is pesticides. • Avoid contaminating yourself.• Brush away any drug chemicals and remove

exposed clothing.

Absorption Poison Emergency Care

• Avoid contaminating yourself.• Brush away any drug chemicals and remove

exposed clothing.• Contact Poison Center – 800-222-1222 for

treatment protocol

Poison Control Center – 800-222-1222• Sanford Poison Center calls are answered by

Hennepin Poison Center at the Hennepin Regional Medical Center in Minneapolis, MN.

• Hennepin Poison Center answers over 60,000 calls year.

• The center is available 24 hours a day, 7 days a week.

• Program the phone number into your cell phone for easy access on an emergency call.

Role of the Poison Center

• To provide 24/7 emergent and non-emergent medical assessment, triage and treatment recommendations for all poisonings

• Service provided to public, pre-hospital personnel and health care professionals

• Telephone based service with a single national telephone number

K2 - Definition

• A popular mixture of herbs and spice that are sprayed with a psychoactive chemical and sold as a legal marijuana substitute in shops and via internet.

• Other names include Spice, Genie, Yucatan Fire, King Krypto, Mr. Nice Guy and Super Skunk

• Chemical name – JWH-015, JWH-018

K2 Nationwide Use

• All U.S. Poison Center Data 2010 – 2,915 calls regarding K2-Spice

• All U.S. Poison Center Data 2011 – 6,348 total calls regarding K2-Spice

K2 and South Dakota Abuse

• Sanford Poison Center Data 2010 – 4 calls regarding K2-Spice

• Sanford Poison Center Data 2011 – 27 total calls – 22 exposures and 5 request for information calls

K2 – Signs and Symptoms of Use

• Marijuana like effects– Red Eyes– Pale Skin– Slow speech– Lethargic movements

K2 – Signs and Symptoms of High Dose or Bad Reaction

• Agitation• Anxiety• Tachycardia• Hypertension• Vomiting• Hallucinations

K2 – Why are they using?

• Obtained legally in many states• Easy to purchase – head shops and on the

internet• Looks like potpourri

K2 – Emergency Care

• Call the poison center at 800-222-1222 for assistance in care.

• Treat symptoms as normal – High Flow Oxygen, etc.

• Obtain Law Enforcement assistance as they could be potentially dangerous due to the hallucination effects.

Bath Salts - Definition

• The substance in question is being marketed as a bath salt but is actually white powder, a chemical composition that is snorted or ingested, inducing pharmacological effects similar to those obtained through cocaine. The chemicals, mephedrone and MDPV, cause dangerous side effects that include severe hallucinations. Named bath salts for it’s appearance, not their intended use.

Bath Salts Nationwide Use

• All U.S. Poison Center Data 2010 – 303 calls regarding Bath Salts

• All U.S. Poison Center Data 2011 – 5,853 total calls regarding Bath Salts

Bath Salts and South Dakota use

• Sanford Poison Center Data 2010 – zero calls regarding Bath Salts.

• Sanford Poison Center Data 2011 – 21 total calls with 18 exposure calls and 3 request for information calls.

Bath Salts – Common Use

• Packaged with labeling of “not for human consumption.”

• Most patients have reported snorting the product.

Bath Salts – Common Names

• Red Dove• Blue Silk• Zoom• Snow• Ivory• Hurricane Charlie• Night Light

Bath Salts – Symptoms of Abuse

• Increased Blood Pressure• Increased and Irregular Heart Rate – Chest Pain• Agitation – more assertive behavior than normal• Hallucinations• Extreme Paranoia• Shaking/Trembling hands - Seizures• Delusions – Complete break with Reality

Bath Salts – Long Term Affects

• Permanent Physical disabilities• Permanent Mental injuries• Death

Bath Salts – Emergency Care

• First and Foremost – Personal Safety – these individuals are at high risk of hurting themselves and others around them.

• Call the poison center at 1-800-222-1222 for assistance in care.

• Treat symptoms as normal• Obtain Law Enforcement assistance

South Dakota Law

State of South Dakota – 2011 Legislative Session - Senate Bill 34

“Any person who possesses, possesses with intent to distribute, sells or distribute a substance knowing that it is to be used in violation of SDCL 22-42-15 is guilty of a Class 1 misdemeanor.”

How You Can Help

• Pass the Word!• Be Role Models.• Provide Prevention Education.

Many resources available.www.sdpoison.org

If you think it’s a poison, what do you do?

Dial 1-800-222-1222

Real Case Studies

• Case 739 – 17 year old patient arrived in ER with a history of seizures. Patient admitted to using “posh” – another name for K2. Patient had additional seizure while in the intensive care unit. Patient was tachycardic, agitated and confused.

Outcome

• Patient was monitored overnight and was discharged the next day. Continued to report paranoia for additional 48 hours.

Real Case Studies

• Case 1809 – 19 year old patient arrived in ER with muscle twitching progressing to muscle stiffness, dilated pupils and rapid eye movement. Patient admitted to using “Night Light” –name for Bath Salts. Patient HR = 181, RR=36, BP 140/56. Pt received high flow oxygen, fluids and benzodiazepines.

Outcome

• Patient was monitored for 24 hours and physical symptoms relieved. Pt transferred to inpatient mental health. Patient continued in the mental health facility for seven days until hallucinating had stopped.

Scenario

• Dispatched to a suicidal patient. Patient admits to smoking K2 approximately one hour ago.

Patient Assessment• Scene Size-Up

– Ensure law enforcement has secured the scene. – No spinal precautions needed patient is threatening suicide

• Primary Survey– General Impression – patient is anxious and paranoid. LOC – altered– Airway – open and clear, RR – 24– Circulation – HR – 100, no bleeding, skin warm to the touch.

– Transport decision - ?• History Taking

– pt admits to taking a product named Spice. Onset of rapid heart rate, anxiety and paranoia. Pt states he is considering suicide. No past medical Hx noted. When do you contact the Poison Center?

Patient Assessment (con’t)

• Secondary Assessment – Psychological/Social• Vital Signs

– Pulse – 100, RR – 24 and regular, BP – 140/90– Field Impression - ?– Interventions - ?

• Reassessment

Scenario

• Dispatched to the local school for a patient who is threatening staff with a knife. It has been identified by another student that the patient had just snorted a product call Night Light.

Patient Assessment• Scene Size-Up

– Ensure law enforcement has secured the scene. – No spinal precautions needed patient is a threat to self and others

• Primary Survey– General Impression – patient is anxious and paranoid. LOC – altered– Airway – open and clear, breathing very fast – Circulation – tachycardic, no bleeding, skin very warm to the touch. – Transport decision - ?

• History Taking – Pt was seen snorting a product named Night Light (bath salts). Onset

of rapid heart rate, anxiety and paranoia. Pt is unable to control actions. Restraints need to be considered. No past medical Hx noted. When do you contact the Poison Center?

Patient Assessment (con’t)

• Secondary Assessment – Psychological/Social• Vital Signs

– Pulse – 140, RR – 32 and regular, BP – 140/90– Field Impression - ?– Interventions - ?

• Reassessment• ALS intercept for IV and drug administration.

Further Information

• Amy Marsh, Poison Control Educator• Sanford Poison Control Center• 605-328-6668• amy.marsh@sanfordhealth.org