Silk Road forums
Discussion => Drug safety => Topic started by: fortystripes on July 22, 2012, 03:51 pm
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Hi everyone, it's good to be here. Until recently I worked as a paramedic, until a stairway collapsed in a vacant building and left me with chronic back problems.
I will be happy to answer your questions about overdosage, venous access, and any other medical questions you might have.
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A neighbor at our festival campground site was doing coke constantly for 9 hours into the morning, upon arrival of noon his heart was racing, felt like he was dying. I offered him 10mg of valium, but before the valium kicked in his friends took him to the medical tent. They didn't give him anything else in the medical tent other than rest,water and a fan (it was hot outside). In this case was the choice of valium harmful or positive?
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You are correct in saying training and experience really doesn't include much in the line of research chemicals, the city where I worked was more awash in heroin, cocaine, and pills than anything else.
I will gladly answer any questions about what happens in an emergency situation to a victim of overdose, whatever the etiology.
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A neighbor at our festival campground site was doing coke constantly for 9 hours into the morning, upon arrival of noon his heart was racing, felt like he was dying. I offered him 10mg of valium, but before the valium kicked in his friends took him to the medical tent. They didn't give him anything else in the medical tent other than rest,water and a fan (it was hot outside). In this case was the choice of valium harmful or positive?
The valium was helpful, as it will blunt some of the sympathetic nervous system effects.
Chilled saline, rest, and benzos are a pretty standard treatment for cocaine overdose. Since cocaine causes blood vessel constriction, and body heat is generated by the resistance of blood traveling through vessels, these folks tend to heat up.
The good news is, cocaine tends to wash out pretty quickly.
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how soon does a heroin overdose happen? what are the first effects of it? how can it be stopped without naloxone
The MOA is going to cause variance, not only due how quickly your CNS is affected, but also due to adulterants being more common amongst those smoking and snorting, opposed to those who will cook a shot to IV. Onset for Smoking and IV is almost instant; snorting can take quite some time (upwards of 20 minutes, especially in users with a baseline tolerance built).
If you are observing someone who you think is overdosed, their pupils will be tightly constricted, discoloration of the tongue, lips and fingernails (blue). Check the pulse, it's going to be weak and if you happen to have a BP cuff handy, their BP would be quite low. For the one who is under the influence, breathing becomes progressively difficult, intense GI cramps/spasms are going to be common.
Someone else will need to address Narcan alternatives.
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Early onset opiate/opioid overdose:
Anxiety, then loss of consciousness
Pale, cool, clammy skin
Weakness, lack of muscle tone
Pinpoint pupils
Developed overdose:
Shallow breathing, low respiratory late (<8 breaths a minute), then apnea
Dusky, blue color of the nail beds and lips, and tongue
Thready pulse, low pulse rate
The good news is, most larger cities are getting a clue and giving out 2mg prefilled syringes of naloxone along with a MAD, or mucosal atomization device. It hooks onto the end of the syringe and turns the liquid steam into a fine mist. Anyone who has insufflated drugs knows that this is a pretty reliable route of administration. Giving 1mg in each nostril usually reverses the effect in a couple minutes, and from my experience people tell me its less "harsh" then the IV route.
I suppose you *could* use naltrexone tablets if you had access to them. The problem is, naltrexone is designed to have a longer half life, and thus, has a slower bioavailability. Given the choice of that or watching someone turn blue and go into respiratory arrest, i'll take the former. The tablets should be prepared in the same way an oxycodone or hydromorphone would, and given intravenously.
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If you don't have anything handy and you're privy to an opiate/opioid overdose, the treatment (after calling 911) is to take over breathing. Delivering rescue breaths will work quite well. You expire 16% oxygen, and the person laying there blue is getting 0%. If you can give them some of the oxygen you're exhaling, the heart rate and blood pressure will pick up as well.
It all traces back to millions of years ago when we had webbed feet, and that part of our brain still exists. The baroreceptors in your aortic sense that you are building up CO2 (holding your breath) and figure you must be underwater. So circulation slows down, reducing your oxygen demand, allowing you to keep diving.
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HOW TO CALL 911
So at this point you have decided that you or someone you know is in need of immediate medical help. Even if the paramedics that show up don't know the ins and outs of whatever was taken, they can still deliver supportive care to keep that person alive. You may know more about some obscure research chemical, but unless you carry the stuff around to paralyze and intubate them, calling for help is a good idea.
About 911 dispatchers 911 dispatchers are some of the worst paid, overworked people you will meet. They make terrible money being yelled at from the phone by callers, and through the radio by firemen, paramedics, and cops. They are not going to expend one extra ounce of energy trying to find out why you *really* called 911. They will just send the appropriate people, and go off to daydreaming.
What happens when you call 911
In any populated area, as soon as your cell phone makes the connection, the dispatcher has access to a bunch of things, including:
- Your number (so they can call you back)
- Your GPS location (so they can find you)
- The home address your phone bill goes to
However, as soon as the call is terminated, they no longer can GPS your phone. This is so they can't find out that their wives are cheating on them. So if you call 911 and then leave, the only address they have is the one you were at when you pressed "send". And since noone uses landlines anymore, people don't really pay attention to the home address thing. If you're using a prepaid or a burner, it doesn't matter anyway.
How to make the call
The idea here is to give them enough information to make sure a paramedic unit is sent your way, but no information that is going to attract unwanted people (fire/rescue, law enforcement).
"MY GRANDMA, SHE'S 96, SHE HAS EMPHYSEMA AND CANT BREATHE VERY WELL".
This is a good thing to say. A medic unit will definitely respond, but cops and firemen usually don't care too much about grandmas dying. 95% of the paramedics/emts in major areas aren't going to complicate their lives by trying to get someone busted. After all, that means getting subpoenaed to testify in court, which you don't get paid to do.
"UH, MY FRIEND HERE, I THINK HE TOOK SOMETHING, HE'S NOT ACTING RIGHT."
This is a poor thing to say. The lack of information here will make the frazzled dispatcher curious, and probably ask a lot of questions. And maybe send the police. They could get you in trouble.
When help arrives, just tell them the truth and leave. Easy enough, right?
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If you don't have anything handy and you're privy to an opiate/opioid overdose, the treatment (after calling 911) is to take over breathing. Delivering rescue breaths will work quite well. You expire 16% oxygen, and the person laying there blue is getting 0%. If you can give them some of the oxygen you're exhaling, the heart rate and blood pressure will pick up as well.
It all traces back to millions of years ago when we had webbed feet, and that part of our brain still exists. The baroreceptors in your aortic sense that you are building up CO2 (holding your breath) and figure you must be underwater. So circulation slows down, reducing your oxygen demand, allowing you to keep diving.
The baroreceptors detect arterial pressure changes, the chemoreceptors detect O2 and Co2 changes. Although the reflex operates in the same way, just instead of stretch receptors there are chemosensitive cells detecting lack of 02 and excess H+ and CO2.
Sorry if I am sounding pedantic.
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Don't lie when you call 911. That's stupid. Terrible advice fortystripes. Tell the truth. Just hide your shit out of plain site and don't give any cop probable cause to search your place. That's usually enough.
Cops are usually only dispatched if the person the paramedics are responding to has the potential to cause harm to the public or to the paramedics. They'll usually keep their nose out of the shit otherwise.