Bath Salts and K12

xrsm002

xrsm002

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I am a new Paramedic student and haven't had much pharmacology except in my intermediate class over NS, d50w, and Narcan, diphenhydramine, zofran, epinephrine 1,1000, and Lidocaine, IO, (which is what my agency allows us to administer) The pharmacology for my paramedic is coming up after Christmas.

Anyways,

I was just wondering if anyone has any experience dealing with these two "new" designer drugs BATH SALTS AND K12 (which are now illegal in all states according to the DEA
I was mainly interested in what treatment was given, I know the bath salts cause increased HR, and BP, along with anxiety, and irritability along with hallucinations and suicidal tendencies. But what drugs seem to work well? I am I mean I was thinking you could (if your service carries these) administer Amiodarone to slow the Heart down, labetolol, to decrease their BP, and maybe Narcan just to CYA?
 
I've had one patient that took K12. It was a 19 year old female that presented with moderate nausea, vomiting, increased HR, chest tightness, and anxiety. Care was supportive. There is no specific treatment for K12. Care is directed at treating the symptoms.

In this case, ECG, Zofran, IV, and monitored throughout transport.
 
18G said:
I've had one patient that took K12. It was a 19 year old female that presented with moderate nausea, vomiting, increased HR, chest tightness, and anxiety. Care was supportive. There is no specific treatment for K12. Care is directed at treating the symptoms.

In this case, ECG, Zofran, IV, and monitored throughout transport.
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Expounding on 18Gs comment, almost all the care we do is based on treating the symptoms, because often the root causes of disease take far longer to treat than the amount of time we spend with patients in the back of the ambulance. Even a complicated or obscure medical issue can receive excellent pre-hospital care if we treat the symptoms correctly.
 
ive had pts that needed to be sedated while on k12. A little versed goes a long way with theese pts.
 
had a patient that smoked a bit of k12 last weekend, like said above, nausea and plenty of vomiting, walked in on scene and patient was laying on the floor staring at the ceiling refusing to respond to anyone because we were white while singing gangsters paradise by coolio, just hooked him up to some o2, 4 lead, started a line and transported
 
I honestly HAVEN'T seen Spice/K12/Bath Salts toxicity yet. And I'm surprised. I supervise a college first-response squad, and have been looking for it for a year.

My medical director echos JPMedic, though. He's seen more than a few, several of which required copious amounts of Ativan and/or Versed in combination with hard restraints in the ED/ICU.
 
Jon said:
I honestly HAVEN'T seen Spice/K12/Bath Salts toxicity yet. And I'm surprised. I supervise a college first-response squad, and have been looking for it for a year.
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I think the bath salt thing is mostly a high school and jr high thing. College kids can score better drugs it seems. Now that it is no longer sold in head shops and is more difficult to find online I suppose the craze will die off a bit.
 
K12 or "Kind" / "Spice" is mostly what they call it here, and We have a BAD problem with this. Bath Salts not too much. I've ran one respiratory arrest with on it, seems the kid aspirated it and just stopped breathing not long there after. Otherwise, it's caused a lot of rapid heart rates, extreme nausea, respiratory issues, panic attacks, and in one cause a bad cause of excited excited delirium (which we are pretty sure he was on something else too)
 
xrsm002 said:
I am a new Paramedic student and haven't had much pharmacology except in my intermediate class over NS, d50w, and Narcan, diphenhydramine, zofran, epinephrine 1,1000, and Lidocaine, IO, (which is what my agency allows us to administer) The pharmacology for my paramedic is coming up after Christmas.

Anyways,

I was just wondering if anyone has any experience dealing with these two "new" designer drugs BATH SALTS AND K12 (which are now illegal in all states according to the DEA
I was mainly interested in what treatment was given, I know the bath salts cause increased HR, and BP, along with anxiety, and irritability along with hallucinations and suicidal tendencies. But what drugs seem to work well? I am I mean I was thinking you could (if your service carries these) administer Amiodarone to slow the Heart down, labetolol, to decrease their BP, and maybe Narcan just to CYA?
Click to expand...

Bath Salts are very similar to other stimulants, and patient's symptoms are close as well. You can expect tachycardia, tachypnea, anxiety and or paranoia/combativeness, hyperthermia/profuse diaphoresis, and generally a hypermetabolic state. I would be VERY hesitant to administer ANY cardiac drugs to these patients. The goal of treatment should be, like stated above, managing symptoms. Treatment should be at decreasing the hypermetabolic state (with valium/Ativan {if you have an IV}, or versed {if you dont have an IV}. That, coupled with IV fluid, should help with the tachycardia. If your patient is extemely hyperthermic, then cooling him down, would be beneficial as well.

As far as the Narcan?!?!?!?! Why do we give Narcan???? Not for any type of overdose, but for only OPIATE overdoses... And not just Opiate Overdoses, but Opiate Overdoses with respiratory depression... So I wouldnt give Narcan either.
 
xrsm002 said:
Narcan is just a cover my butt kinda thing.
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Just a comment to help you to think alittle more on CYA narcan. If you have a PT. with either an expected bathsalt OD (or any stimulant overdose for that matter) and that patient is tachy(this has nothing to do with what he is wearing), warm dialated pupils muscle spasms rapid resp rate why would you want to give him narcan? he is already really excited right. so even if he is on a narcotic that may be the only thing keeping him down alittle. Now if he has resp supression or other signs and symptoms of narc OD and you give narcan and he goes into excited delirium("speed ballin"this is why we titrate our narcan anyway) thats just how it happens. Either way ativan will be your best friend
 
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xrsm002 said:
Narcan is just a cover my butt kinda thing.
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Ahhh... I love cookbook paramedics.



I concur - if the problem is stimulant OD... why take away any downers that are there.
 
The long term effects of these things are the scary part. I know of a few that have had their lives completely ruined by K-2. Gone from good students and athletes to needing help with the basics of self care. I dont see wher Narcan is going to have any benefit in treatment. The best we can do is give good supportive care and get them to a facility for advanced and long term care. More than likely if the patient presents with an altered LOC they are going to be altered for a long period of time,possibly for months maybe years and from what I have seen this could be permanent. I have not had any experience with these in the field but have seen them in a hospital setting after the acute phase is over.
 
The one I ever came in contact with we gave versed and O2. Thankfully it didn't get to the point of restraints. Giving Narcan for a non-opiate is pointless, the goal is to give as little medication as possible.
 
The only thing we can really do is provide supportive care and protect the patient from themselves if it comes to that point. It's been running rampant here, we've used quite a bit of versed in the last couple of months.
 
If my limited research of the subject is correct, and both drugs have stimulant effects similar cocaine and methamphetamine , benzo the ever-loving crap out of these people. I prefer midazolam myself for rapid onset.

Avoid beta-blockers. Unopposed alpha stimulation is a bad thing.
 
We were having a real problem with it here in Missouri. Both K2 (never heard of K12) and K-3 when they made K-2 illegal. Then the bath salts hit. Now they are all illegal and it has slowed a little.

I had one guy in 5 point restraints that had snorted the bath salts 4 days prior. He was still tripping.

I had a guy in his 50's at the bus station that had smoked K-3. Pupils dilated, temp elevated, pulse and B/P through the roof c/o syncope and chest pain.

Last was a 14 y/o female that ended up on propofol and intubated (in the ER)

haven't had any in the last couple of weeks.......... we were just starting to joke about the good ole days where people just used meth :)
 
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