# Spice and Bath Salts



## CMillican (Apr 4, 2011)

I've been doing a lot of research into spice (k2, spice, legal bud) and these bath salts that kids are doing. Has anyone experienced extreme cases of things going wrong with a patient that has ingested these things? If I do get an extreme case, what's my best course of Rx (bls)? I'm very worried because the county im going to work in, these things are major problems. I've heard of kids as young as 12 years old doing it. I mean kids think that since people are selling it, it's harmless.

If you can share the pt. vitals so i can see if there is a trend I could follow


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## CMillican (Apr 4, 2011)

Sorry, wrong thread, can an admin move this to EMS talk please?


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## medicRob (Apr 4, 2011)

CMillican said:


> I've been doing a lot of research into spice (k2, spice, legal bud) and these bath salts that kids are doing. Has anyone experienced extreme cases of things going wrong with a patient that has ingested these things? If I do get an extreme case, what's my best course of Rx (bls)? I'm very worried because the county im going to work in, these things are major problems. I've heard of kids as young as 12 years old doing it. I mean kids think that since people are selling it, it's harmless.
> 
> If you can share the pt. vitals so i can see if there is a trend I could follow



Spice (JWH-016 and JWH-018) are synthetic cannabinoids, that are according to lab tests 3x as powerful as cannabis. 

Effects you may note: 

Increased heart rate, Nausea/vomiting, HTN, headaches. 


Bath salts as they are called or (MDPV 3,4-methylenedioxypyrovalerone) is not really a bath salt, it is just sold as such to avoid the Federal Analogue act, just as mephedrone and methylone are sold as "Pond Cleaner and Plant Food".

All of these compounds are known as research chems, there are thousands of them... you haven't begun to see the half of it. 

MDPV, BK-MDMA, 2C-i halo, 2C-t-7, 4-OH-DIPT, 4-OH-MIPT, 5-MeO-DMT, 5-MeO-DIPT, 2,4,6-trimethoxyphenythalamine (TMA-6), 5-IAI, Methcathinone (CAT), Propylhexedrine(aka Levo-metamfetamine), and tons more. When one becomes scheduled, another replaces it. They can be purchased online or at any head shop.. RCs and entheogenical bioderivatives are here to stay. 

MDPV (sold as Bath Salts and Pond Cleaner) is a norepinephrine-dopamine reuptake inhibitor with properties similar to that of Molly (3,4-methylenedioxy-methamphetamine and methamphetamine).. These drugs act on the sympathetic nervous system resulting in Tachycardia, Pupil dilation, paranoia, and possible psychosis. 

The patients you will come across who have ingested MDPV will more closely resemble an individual in meth psychosis. These drugs act primarily by releasing large amounts of dopamine (The pleasure reward chemical) resulting in a high potential for redosing and dependency. 

The effects of these 3,4-methylenedioxy-ring substituted pyrovalerone compounds typically last anywhere from 2 - 7 hours depending on a variety of factors including metabolism, dose taken, and whether or not the indvidiual has redosed. 

Symptoms can include: 

Tachycardia, hypertension, pupil dilation,  insomnia, grinding of the teeth (bruxism), headache, increased body temp (NOTE THIS), nausea, digestive problems, kidney pain, dizziness, tinnitus (rare), agitation, hallucination and/or delusion /c general lack of reality testing, and in some cases breathing difficulty. 

Treat these patients as you would an individual under the influence of amphetamines.  

----

My background in chemistry has allowed me a special insight into the designer drug scene and as such, I keep up with all of these substances regularly to act as a contact point for emergency medical providers in my medical center with regard to their effects, presentations, etc. 

For all of you noticing an increased volume of calls due to the ingestion of these various substances that wish to get with your medical director and service directors to come up with protocols and in-services, feel free to contact me via PM, and I will provide a detailed write up and explanation of the latest designer chems along with several resources you can provide to your directors/officials for protocol writing and in-servicing of employees.


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## FreezerStL (Apr 7, 2011)

Thanks for the info medicRob ^_^

There is a pretty nice article over at JEMS about this stuff...
http://www.jems.com/article/news/synthetic-drugs-sending-thousa


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## ffemt8978 (Apr 7, 2011)

Moved to appropriate forum


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## subliminal1284 (Apr 7, 2011)

Im not sure about the bath salts but I wouldnt worry too much about the synthetic cannabis, people who consume cannabis even in large amounts at a time very rarely have any serious immediate life threatening effects, I would be more worried about alcohol poisoning than someone overdosing on cannabis.

With that said all that you could really do for that as a basic or a paramedic even is put them on O2 and transport.


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## mc400 (Apr 8, 2011)

I have had a recent surge in Spice related calls. After smoking the usually get an elevated HR, sudden onset of anxiety and nausea. BP usually runs Hyper but has seen some Hypo but most likely due to severe vomiting....Users tent to say it makes them spin, feel anxious and hallucinate. IV, 02, Zofran, ALS monitoring is about what you can do, fluid bolus as well.


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## mc400 (Apr 8, 2011)

Ah reads the above posts and see what I wrote weas already said and said much better lol.


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## enjoynz (Apr 8, 2011)

I hadn't heard about the above products  be abused by kids. 
Although I did learn something new a short time ago.

Vanilla Essence

My husband works at a general store and they are not allowed to sell kids more than one bottle of vanilla essence at a time.
Kids are sculling bottles of the stuff because of the alcohol contant in it.
I googled the product and found out that imitation vanilla essence has a 35% alcohol content.
Know wonder they are purchasing it, to get a buzz.:glare:

Enjoynz


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## Sandog (Apr 8, 2011)

subliminal1284 said:


> Im not sure about the bath salts but I wouldnt worry too much about the synthetic cannabis, people who consume cannabis even in large amounts at a time very rarely have any serious immediate life threatening effects, I would be more worried about alcohol poisoning than someone overdosing on cannabis.
> 
> With that said all that you could really do for that as a basic or a paramedic even is put them on O2 and transport.



As a synthetic cannabis, and since the product has not been tested in clinical trials, the ADME, and toxicology of this product is not well known. Side effects can be very different than that of cannabis, without lab data, who knows? Synthetic does not equate to identical; I would take a less cavalier approach to this new trend...


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## 281mustang (Apr 8, 2011)

subliminal1284 said:


> Im not sure about the bath salts but I wouldnt worry too much about the synthetic cannabis, people who consume cannabis even in large amounts at a time very rarely have any serious immediate life threatening effects, I would be more worried about alcohol poisoning than someone overdosing on cannabis.
> 
> With that said all that you could really do for that as a basic or a paramedic even is put them on O2 and transport.


 It's impossible to overdose on cannabis, pot is one of the few substances that can't be overdosed on. 

Synthetic cannaboids are cannaboids soley in the sense they have pot-like effects, comparing them to actual marijuana is apples to oranges.


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## Sandog (Apr 8, 2011)

> It's impossible to overdose on cannabis, pot is one of the few substances that can't be overdosed on.



Hmm, check out Paracelsus



> "All things are poison, and nothing is without poison; only the dose permits something not to be poisonous."


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## Asimurk (Apr 8, 2011)

281mustang said:


> It's impossible to overdose on cannabis, pot is one of the few substances that can't be overdosed on.
> 
> Synthetic cannaboids are cannaboids soley in the sense they have pot-like effects, comparing them to actual marijuana is apples to oranges.



"One estimate of THC's LD50 for humans indicates that about 1,500 pounds (680 kg) of cannabis would have to be smoked within 14 minutes." - WikiPedia

Impossible, eh?  We'll just see about that.


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## medicRob (Apr 8, 2011)

I am heading out to my ACNP Review this morning, so I don't really have time to post right now, but expect a post from me later today explaining the biochemistry of the synthetic cannabinoids (3x more potent than THC btw) and their various reactions with the body, as well as refute whomever it was that said they werent that worried about synthetic cannabinoids. 

Any biochemist will tell you there are drugs all around you. As I have said above, there are thousands of recreational research chems and entheogenical bioderivatives. Hell, one can walk into a local wal-mart with $10 and come out with a product that can contain morphine in varying ranges (NO, I WILL NOT BE SHARING THAT, DONT PM). One can walk into a walgreens, buy a certain type of inhaler (not vicks), put the cotton in water, drink it and have a methamphetamine type high.. Designers/Research/BioEntheo's are not going away. 

Also, please don't generalize the chems so much. Someone making a claim as to all synthetic cannabinoids having the same effect and danger risk is like me saying that all derivative narcotics of the papaver somniferum are the same thing, or worse that all narcotic drugs are the same thing. 

Please specify which one you are referring too:

JWH-015, JWH-018, JWH-073, JWH-081, JWH-133, JWH-200, JWH-250,
JWH-398, CP 47,497, CP 55,244, CP 55,940, HU-210, HU-211, or WIN 55,212-2

--
One risk is hallucination-related suicides, etc. 

I present: 
http://www.desmoinesregister.com/ar...ynthetic-drug-ban-can-Indianola-teen-s-legacy

http://www.hawaii.edu/hivandaids/Ce...Males_Associated_with_Acute_Marijuana_Use.pdf

I'll be back later with some posts, maybe even some chemical comparisons on the topic.


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## samiam (Apr 8, 2011)

Sandog said:


> Hmm, check out Paracelsus




Oxygen Toxicity aka Hyperoxia 

Water Toxicity aka Hyper-Hydration

Orange Toxicity aka Too much d-limonene (yes I am aware that most people dont eat the peel)

Car Toxicity aka SPLAT!

Life Hurts Get a Helmet


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## cruiseforever (Apr 8, 2011)

Sandog said:


> As a synthetic cannabis, and since the product has not been tested in clinical trials, the ADME, and toxicology of this product is not well known. Side effects can be very different than that of cannabis, without lab data, who knows? Synthetic does not equate to identical; I would take a less cavalier approach to this new trend...



Death in MN from the stuff.

http://www.startribune.com/local/north/118182584.html


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## medicRob (Apr 8, 2011)

Sandog said:


> As a synthetic cannabis, and since the product has not been tested in clinical trials, the ADME, and toxicology of this product is not well known. Side effects can be very different than that of cannabis, without lab data, who knows? Synthetic does not equate to identical; I would take a less cavalier approach to this new trend...



There is lab data. I have it. I'm on my way back now, will share shortly.


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## reaper (Apr 9, 2011)

I have seen many cases with K2, since it was developed by me. They very widely and can range from minor to fatel.

Never underestimate a designer drug.


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## jwilbz03 (Apr 9, 2011)

reaper said:


> I have seen many cases with K2, since it was developed by me. They very widely and can range from minor to fatel.
> 
> Never underestimate a designer drug.



You developed the drug? These synthetic drugs have become a huge issue. I have even had a friend who was twenty two years old die from bath salts a few weeks ago. I have seen countless kids come to the ER with elevated heart rates, emesis, etc. Most of them think they are going to die when they are high off these drugs, however a common trend of these "bad highs" seem to be from mixing these drugs and/or overdosing. They think it's safe to take as much or any at all because it is sold publicly. Complete BS. . .


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## reaper (Apr 9, 2011)

No I didn't develop it. It was developed in the town by me.

Most states have now started outlawing their sales in stores. So it cuts down a little on them.


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## TreySpooner65 (Apr 9, 2011)

medicRob said:


> There is lab data. I have it. I'm on my way back now, will share shortly.



Looking forward to the data.


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## Veneficus (Apr 9, 2011)

*during my first hazmat course*

The instructor went over the 4 ways to be exposed to a hazardous chemical.

First he had a picture of a fire officer that looked like it was from the 70's tasting an chemical leaking from a tank car. The instructor's comment was: "If you eat an unknown chemical you get whatever you deserve."

Next he had a picture of a a guy in a white lab coat sniffing a beaker. His comment: " If you sniff an unknown chemical, you deserve whatever you get."

Not to be outdone he had a picture of a family putting on sunblock, stating "If you take an unknown chemical and rub it all over your skin, you deserve whatever you get."

Finally he had a picture of somebody with a hyperdermic needle and a constricting band. "If you take an unknown chemical and inject it into your veins, well..." (he left it at that)

About 1st grade kids start hearing "don't use drugs." That is drilled again and again. There are posters, clubs, tv commercials, pamphlets and all manner of materials and dissemination of the message. 

If somebody kills themselves with a "designer drug" or any other drug, it is not a tragedy. It is natural selection. 

Whether that drug comes in a bottle from the local gas station, mailed through the internet, or purchased through the homeboy pharmacy network,it takes only the most basic of intelligence to know that you can die from it.

Stupid kills. There is no cure for stupid. In the meanwhile we must continue to wave our fingers at Darwin and treat the symptoms.


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## 281mustang (Apr 9, 2011)

Veneficus said:


> Whether that drug comes in a bottle from the local gas station, mailed through the internet, or purchased through the homeboy pharmacy network,it takes only the most basic of intelligence to know that you can die from it.


 You can "die" from nearly anything. _Everyone_ has done stupid things in their youth, the process of growing up consists of mostly trial and error.

A high school kid overdosing isn't necessarily an inclination of sub-standard DNA but rather the experimenting mentality of an adolescent combined with an unfortunate series of events. 

Taking the stance of "any kid that ignores their DARE lecture and takes drugs deserves to suffer a fatal overdose" is extremely ignorant and presumptuous. Not to mention the fact that those lectures notorous for throwing in misinformation in an attempt beat a dead horse which only serves to promote drug use after they discredit the entire source.


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## Veneficus (Apr 9, 2011)

281mustang said:


> You can "die" from nearly anything. _Everyone_ has done stupid things in their youth, the process of growing up consists of mostly trial and error.



Some survive to reproduce, and some don't.



281mustang said:


> A high school kid overdosing isn't necessarily an inclination of sub-standard DNA but rather the experimenting mentality of an adolescent combined with an unfortunate series of events.



This sounds like trying to put the blame on somebody else or shift responsibility. Poor decision making gets people killed all the time.

Some people choose not to experiment with mind altering substances, some people choose to and survive, some people choose to and don't. It happens with every generation, but a preventable death is still not tragic. 



281mustang said:


> Taking the stance of "any kid that ignores their DARE lecture and takes drugs deserves to suffer a fatal overdose" is extremely ignorant and presumptuous.



It was not my intent to suggest that these people deserve a fatal overdose, I used the experience of my early education to demonstrate that drugs are hazardous chemicals, the forms by which they are taken, and the absurdity of using them and thinking it is somehow safe or that harm won't come to them.

I didn't choose the instructor's words, I accurately described the experience.

The reasons people use drugs are many. The consequences are always the same. They are predictable and not beyond control. They are all prevented by the same behavior. (Or rather lack of it) Again, I find nothing tragic about it. Responsibility rests with the individual.



281mustang said:


> Not to mention the fact that those lectures notorous for throwing in misinformation in an attempt beat a dead horse which only serves to promote drug use after they discredit the entire source.



Back in the day when ships were wood and men were iron, we didn't have dare lectures. There are many sources of information available and accessable in which to base sound decision making from. Some people ignore it. But if you tell people that laying down in traffic on the freeway could get you killed, I don't see too many of them rushing out to show off how wrong that information is. 

Using or experimenting with drugs is no different from any other high risk behavior. Sometimes you get a second chance. Sometimes you don't. But the moment a person chooses to play, they are soley responsible for the outcome.


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## jgmedic (Apr 9, 2011)

Veneficus said:


> The instructor went over the 4 ways to be exposed to a hazardous chemical.
> 
> First he had a picture of a fire officer that looked like it was from the 70's tasting an chemical leaking from a tank car. The instructor's comment was: "If you eat an unknown chemical you get whatever you deserve."
> 
> ...



No, didn't you hear, we actually outlawed a sense of personal responsibility a few years back. If something bad happens, it automatically is someone else's fault.


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## Veneficus (Apr 9, 2011)

jgmedic said:


> No, didn't you hear, we actually outlawed a sense of personal responsibility a few years back. If something bad happens, it automatically is someone else's fault.



Seemingly that is the case.


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## 281mustang (Apr 9, 2011)

Veneficus said:


> Some people choose not to experiment with mind altering substances, some people choose to and survive, some people choose to and don't. It happens with every generation, but a preventable death is still not tragic.


 This seems to be where we part ways. Maybe it's just from all the stupid things I did when I was young but I share a degree of empathy for kids that get burned after taking risks. Not to the extent that many others do, but to some degree nonetheless.



Veneficus said:


> Using or experimenting with drugs is no different from any other high risk behavior. Sometimes you get a second chance. Sometimes you don't. But the moment a person chooses to play, they are soley responsible for the outcome.


Very well said. I can drink to that.


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## medicRob (Apr 9, 2011)

JWH-018 Data (See Attached)

because I am limited to 3 attachments, I will make a double post.


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## medicRob (Apr 9, 2011)

JWH-018 Data pt 2 (See attached)


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## Sandog (Apr 10, 2011)

Thanks for sharing the data. Note; rats and humans are not perfect analogs, but what hurts a rat, usually does the same to us.
If I ever want to become catatonic I know what to get, usually I just listen to me wife though...


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## Veneficus (Apr 10, 2011)

281mustang said:


> This seems to be where we part ways. Maybe it's just from all the stupid things I did when I was young but I share a degree of empathy for kids that get burned after taking risks. Not to the extent that many others do, but to some degree nonetheless.




It is not that I don't empathise with them or even sympathise in various circumstances. 

I just don't see it as an unforeseeable or accidental. Certainly it is not surprising.

I have even encountered people whos substance abuse problems are the least of their worries and probably the only thing they can do to cope. But in the end, it doesn't change the outcome.

As I said in my original statement, we continue to do all we can anyway.


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## MediMike (Apr 13, 2011)

Had a 30y/o winner decide to smoke some Spice today, walked into the kitchen, went into a tonic phase, smashed his face into the dishes in the sink followed by a header into the open dishwasher, and a lil' "seizure like" activity per roommate.  GCS of 8 on our arrival, sinus tach at 170.  Came around with some noxious stimuli but still pretty bashed up.  Starting to get it fairly big in our area. Fun.


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## 1stHandHelps (Apr 13, 2011)

*Its the OTC aspect*

I am not surprised when I hear of these horrific injuries anymore. Peple have this common misconception that because it is legal and available at the local grocer, it can't do any permenant damage. The synthetic dope has the potential to do some harm, but I have seen several individuals go from productive members of society to schizophrenic nut cases after messing with bath salts. In a city about 40 miles from where I live, police found a man in his underwear attempting to swim up a snow covered hill side in an effort to get away from the snipers. Scary stuff man.


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## VirginiaEMT (Apr 26, 2011)

jwilbz03 said:


> You developed the drug? These synthetic drugs have become a huge issue. I have even had a friend who was twenty two years old die from bath salts a few weeks ago. I have seen countless kids come to the ER with elevated heart rates, emesis, etc. Most of them think they are going to die when they are high off these drugs, however a common trend of these "bad highs" seem to be from mixing these drugs and/or overdosing. They think it's safe to take as much or any at all because it is sold publicly. Complete BS. . .




My neices father, "the baby daddy", is in ICU right at this present time due to bath salts. This stuff is not to be experimented with.. Spice is now illegal in Virginia.


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## 1stHandHelps (Apr 27, 2011)

*Bath Salts should be Sched.1 Nationwide*

I am sorry to hear about your neices father. What really blows my mind is all of the online drug forums with people screaming about the government stepping in and taking away a "fun time" just because some people don't know how to use in moderation. Are these people serious?! Imagine a world where heroin, coke, crack, meth, and lsd were sold legally at every gas station and corner store. Drugs of this caliber have no business enjoying any status other than schedule one narcotics and I am outraged that bath salts are not under a nationwide ban already.


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## Veneficus (Apr 27, 2011)

1stHandHelps said:


> I am sorry to hear about your neices father. What really blows my mind is all of the online drug forums with people screaming about the government stepping in and taking away a "fun time" just because some people don't know how to use in moderation. Are these people serious?! Imagine a world where heroin, coke, crack, meth, and lsd were sold legally at every gas station and corner store. Drugs of this caliber have no business enjoying any status other than schedule one narcotics and I am outraged that bath salts are not under a nationwide ban already.



You realize of course that a "bath salt" not meant for medical purposes is not banable under medication schedules?

Considering that many common substances can be used as medications to produce mind altering effects, everything from paint to antifreeze, and a host of indiginous plants as well, I maintain, the solution to illicit substance use is a social issue. 

The solution will not be medical or legal.


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## 1stHandHelps (Apr 27, 2011)

*Understood*

I apologize for my poor choice of words. Bath salts can not be banned as a medicinal substance or banned as "bath salts" in general. The only ban possible is on specific active ingredients such as mephedrone that are responsible for the deadly side effects. I do understand also that whenever one chemical is banned there are 50 chemists waiting in the wings with a new chemical that differs by only one or two side chains and produces the same result without being included in the ban. It is definately an uphill battle, but getting it out of the stores will be a big first step to lessen the occurrence of overdoses and emergency room visits. I am happy to say that just last week all locations for one major chain of head shop stores (perhaps the most popular and well known of all) decided to pull all bath salt products from their shelves for good. It's a small step, but a step in the right direction.


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## smcderby230 (Jun 18, 2011)

*Bath Salts info for presentation.*

Hello:

I am a Delaware State Trooper.  I was recently transferred to the Aviation Section as a Trooper-Medic.  I am currently in school to get my EMT-P Certification.  I have to do a presentation for one of my classes.  I have chosen to do my presentation on bath salts as it is applies to emergency care.  I would appreciate any information you could provide.  

Take care and be safe,

--Sean.


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## FreezerStL (Jun 18, 2011)

> Hello:
> 
> I am a Delaware State Trooper. I was recently transferred to the Aviation Section as a Trooper-Medic. I am currently in school to get my EMT-P Certification. I have to do a presentation for one of my classes. I have chosen to do my presentation on bath salts as it is applies to emergency care. I would appreciate any information you could provide.
> 
> ...



http://www.jems.com/article/patient-care/new-drug-has-dangerous-potential-patient


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## LucidResq (Jun 18, 2011)

This stuff is messed up. Had responders find folks with bath salts... and a bathroom with feces-covered pieces of toilet paper stacked literally waist-high recently. Among many other problems.


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## smcderby230 (Jun 21, 2011)

Very helpful.... Thank you very much.

Take care and be safe,

--Sean.


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