 So you've been taking any drugs, I don't I don't I don't take drugs. No, I don't take drugs. No, no Just what do you take today? What did you take today? Take acid. All right, so then how you gonna what do you know about it? Well, you can tell me I can't tell you don't you can't you can't explain now What's going on in your brain? You can't tell somebody how what's happening? What's going on in your mind like you why don't you just try? Every physician recognizes the feeling of satisfaction that comes with the successful handling of a life-threatening emergency Among the most difficult and yet most frequently encountered today is the drug abuse emergency Often the situation is complicated by histories that are notoriously unreliable And by conflicting signs and symptoms brought on by unknown combinations of drugs proper diagnostic techniques Coupled with appropriate emergency measures invariably produce rewarding results One of the drug emergencies seen with increasing frequency is the heroin overdose Harrowing overdose and barbiturin intoxication Sometimes present a similar clinical picture. There are however several Distinguishing signs with heroin the pupils are 10 points whereas only minor Constriction or not at all occurs in barbiturin intoxication And then the habitual heroin user a permanent set of tracks is usually visible Naline is a specific antagonist for heroin clean is usually both rapid and dramatic Patients do not always react aggressively Precise diagnosis is essential should the heroin overdose be complicated by barbiturin intake Naline may add to the patient's already depressed respiration Narcan another heroin antagonist does not depress respiration Even when barbiturin have been taken at the same time dramatic recovery the patient is not discharged immediately Vital signs must be checked every half hour for at least two to three hours If the patient relapses Naline or Narcan is administered again and the vital signs checked over the next three to six hours Action is important in both diagnosis and treatment since respiratory failure is an ever-present danger In all central nervous system depressant abuse Immediate resuscitative measures should be available Ranging from simple mouth-to-mouth resuscitation Where the situation precludes any other possibility to the more sophisticated means of support such as endotracheal intubation and tracheostomy Changing the unresponsive patients position periodically prevents the development of hypostatic pneumonia characteristics of barbiturin intoxication are confusion Staggering gait drowsiness drunken behavior slurred speech fraud memory and irritability The present effects are heightened significantly when the drug is taken in combination with alcohol Multiple drug abuse presents a more complicated picture a Marked set of needle tracks in the barbiturin abuser may indicate heroin addiction as well They're often collapsed because of repeated heroin injections Necessitating a cut down for the administration of fluids and medications or for blood samples When there is some doubt as to how the drugs were taken a gastric lavage is done We don't Sodium amatol is used to control and prevent convulsions in the chronic barbiturin abuser Other anti-convulsants such as dilatin are ineffective for this purpose Fisher Regardless of how near death they may appear an overwhelming percentage of drug abuse patients respond to effective emergency treatment When the emergency is over a withdrawal schedule with elixir of nembutol or second all is set up for the chronic barbiturin abuser In other cases of barbiturin intoxication for example the kind seen after a single overdose Somewhat different problems arise Put this down and I need you to help me. It doesn't hurt, but it's uncomfortable All right, take it easy when I tell you to I want you to swallow. Okay, all right, take it easy Take a couple deep breaths Swallow swallow The possibility of suicide is a principal concern Even when the patient denies any thought or intention of self-destruction When was this before last night before last and what happened We had to get the back window open to let the smoke out was there anybody with you The fire department came you didn't see a doctor about your risks. No, I did. It's happened the night before last Was it a bad fire? And did you you broke the glass in the window? Yes Well, how did you get your risks For your wrist What were you thinking about when you took the pills just to disgust it, you know just Very depressed was anybody in the house when you took them. I took them at the restaurant The restaurant tape is closed Was there anybody around or did you take the place so I took them by myself This is just the past two weeks because of all the problems in the drinking In many cases no signs of suicidal intent are apparent Nevertheless, the depressant drug abuser should always be submitted for a psychiatric evaluation How did you get in touch with somebody I called my parents because my husband wouldn't send for an ambulance I got panicky at the last minute And they asked him to call the ambulance and he wouldn't be just sat there in the lab your husband Yes, do you believe you've taken it if inadequately treated Arbitrary abuse may result in psychosis depression of the respiratory center convulsions and in some instances death Amphetamine abuser generally presents a picture of verbosity hypermotility euphoria aggressiveness and paranoid ideation You're feeling just the way you usually do Excited Has anything been happening to you recently You know just sit down Peter Tell me do you have a headache? Tell me why you why I don't know I don't know my grandmother brought me here for no reason Do you feel any palpitations in the chest? No, no dizzy Do you feel nervous round this way? Yes, you are jumping around Ask you a few questions and I'd like to examine you briefly now You feel exactly the way you always do What's with the door Ask you a couple of questions. I want to take your blood passion to make you feel better Just take your jacket off and I'm there to take your blood Would you sit down row your sleeve up? I'd like to take your blood Have you been taking any I don't do that kind of have you ever taken speed? How about Dexy? No, you haven't done that This is for Elevated blood pressure Tachycardia Increased respiratory rate and fever are frequently found in amphetamine abuse emergencies Some users, however, develop a tolerance to the drug and these symptoms may not be present When you say I just hold your your hold your head still and look right at my nose look at my Okay, okay, I'm gonna give it my injection about Feel a lot better You're not I feel good Cases medication is unnecessary we're indicated. However, the drug of choice is Valium Just sit down tell me Are you sure you haven't been taking any tablets of any kind I don't take You're not telling me the truth Peter Then you don't know what speed it did you use it at all did you take ever taken Sit down Peter Have you taken a single dose for the first time? recently At a party where you at a party Did you smoke anything did you take any tablets any liquids? No, I think you're lying to me. Did you take anything at all? Well, there was this They had this water and then there was some kids were shooting up, but How about you? Now you're feeling a little better now. Oh, yeah No Okay, you have any unusual Sensations if you feel your heart jumping around Do you have a headache at all? No Do you feel better these with you? Yes? But were you very afraid of something a little while ago when you came in? No, I just want to know what's going on Well, you've been to the doctor before Recovery after an amphetamine binge can be misleading The patient's apparent improvement may be in fact a mask for underlying depression and suicidal ideation Therefore psychiatric consultation is indicated now what you need to do now is to go home and then I'd like to see you in the morning and Exam you again and see if there are any after effects of this medicine Come in with grandma and it won't take much time, and I think it will be good for you The most dangerous hallucinogen is lsd Other substances whose abuse results in similar emergencies are mescaline DMT STT and THC or more potent forms of cannabis He got sick and Tonight My guess I'm just holding his Nobody just made him sick I Mean taking anything What's your name, huh, do you know your name? Which hospital you need to know that well we want to know what he took Just the usual Today Just what do you take today What did you take today Today yeah, what did you take before you? Because they why did you come to the emergency? Yeah, why is a mistake? Yeah, why? Because he said he didn't feel good I came I came into the fucking emergency room because I didn't cuz I took some acid and I don't but and it's not This isn't going that's not going good There are many similarities between the lsd Bad trip and the amphetamine abuse emergency, but there's one major difference Speed overdose is usually characterized by paranoid behavior While the lsd bad trip produces visual hallucinations, which may be frightening to the patient Just What's running down It wasn't on the best So they said that's why it was nice This is the only bad trip you had he was getting crazy What happened after you took I'm not a physician I have to find out so what you want to know I feel right It's great. Yeah, we could put him in a wheelchair To someone you know you can talk to someone in a place that's a little nicer looking than this You know without all this medical stuff. It's okay. You know, you know, it's all right I'm going to go get the wheelchair Okay Yeah, it'll be it's a nicer room and it's quieter and doesn't have all this medical equipment around And you could just sit and talk to someone Okay She's with a very nice lady and everything's gonna be okay As a rule the treatment consists of talking the patient down In rare instances a tranquilizer such as valium may be useful Flying this kite I flew this kite I was walking on a hill. I was on this hill And uh, and I picked it up and ran down the hill and it got off so the next week I went And I bought a japanese beetle kite and put it together and uh There are no hard and fast rules for talking a patient down But several points should be kept in mind It works best in a warm friendly atmosphere Physical contact is important as well as the physician's manner of talking Listening and relating to the patient What's what's your overall feeling my overall sensation? Yeah feeling Inside and then you know, I Keep thinking about the same fucking thing keeps driving into my brain and it keeps coming back, you know And and the thing that keeps coming back Is that I want to get out of here No, it's good to stay and let's get away from you. Yeah, let's let's talk a little bit more about It's really hard. It's really hard Going through What does it feel like? It's good Feels better in here than it does little if you sit down you're still a little wobbly This is like that It's the only time that I can straighten anything out. How would you straighten anything? All alone by myself with nobody talking nobody hassling nobody Just being just being that's all just existing just fucking being that's all Just a alone Just fucking being that's just just feeling the energy that's in my body because I know what I'm doing Then take a fucking drug and it's just affecting me this way because I don't even think I can just tell myself what's happening You know, you see it doesn't really it doesn't really mean Looks like you've leveled off considerably. How do you feel now? Feel drained pretty bad scene Why why would you want to go through something like that? Was that pleasant? This isn't the first time no, but it never happened like that before I said before but you never had a bum trip Never had anything like that ever happened to me flashbacks are Stop you from using the future has for you. What do you want to do for yourself?