Bath Salts and K12

K12 treatment

Went on a k12'casethis weekend as a student. Pt was a 16 yo female, c/o vomit, vomit, vomit. Pt was responsive to verbal. We basically put her on O's, 18 g, tried 0.4 of narcan to rule out...didn't work, then 4mg of zofran. Didn't help..vomit, vomit, vomit....bad stuff
 
dahus7712 said:
Went on a k12'casethis weekend as a student. Pt was a 16 yo female, c/o vomit, vomit, vomit. Pt was responsive to verbal. We basically put her on O's, 18 g, tried 0.4 of narcan to rule out...didn't work, then 4mg of zofran. Didn't help..vomit, vomit, vomit....bad stuff
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Just a thought:

* Does a lack of response to 0.4 mg of narcan really constitute a rule out? Aren't there plenty of synthetics out there, including methadone and darvon, that might not show any increased respiratory drive / alertness with this dose?

It's probably clear from previous posts that I fall into the anti-narcan group, especially if there's any question about mixed overdose, and it's likely that airway management is in the near future.

But if I did choose to give narcan, because I believed that an isolated overdose was present and that I could avoid intubating someone, I'd start with 0.4 mg, quite slowly, but I'd be ready to give more if it wasn't working. I wouldn't take a lack of response to a single 0.4mg dose as some sort of evidence that the patient's altered LOC is not due to opiates.
 
We had a soldier die from bath-salt related aspiration (bath salts + lots of alcohol). We're also noticing some longer-term psychological affects in the psych ward that a lot of the providers up there are curious about.
 
Trevor said:
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.
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Trevor pretty much nailed this, though I wanted to add some clarification.

Bath salts and K12 do act very much like stimulants and 'primarily target' the CNS and to a great degree the autonomic nervous system; which regulates involuntary bodily functions ---- e.g.. cardiovascular, respiratory and endocrine systems. Hence, the cluster of symptoms encountered in patients taking these drugs, present as a 'hyper-metabolic' and 'overly vigilant' ( the paranoia and combativeness) state! All these symptoms, the HBP, hyperthermia, diaphoresis, tachycardia, tachypnea, vomiting and probably pupillary effects, are indicators of a CNS / autonomic nervous system that is in overdrive and resulting in multiple, systemic effects!

Getting back to xrsm002's original question. If I may, Wanting to give a patient under the influence of bath salts or K12 cardiac meds to lower BP and slow the heart rate (likely due to adrenaline overload, from the autonomic effects of the causative drugs) is akin to attacking an enemy on it's flank and piecemeal, in a sense; when a full on frontal assault is called for!

As these drugs are primarily acting on the CNS, you want to attempt to calm the CNS and any number of anxiolytic, sedative type medications will help in doing so. Hey, if the patient is on telemetry and you're in direct contact with the ER physician and he or she thinks the anxiolytic's and other, already mentioned, supportive measures are not doing enough, they may well order cardiac meds to be administered if they feel it necessary.

Peace.
 
Out of curiosity, do they actually have any use in a bathtub?
 
RedAirplane said:
Out of curiosity, do they actually have any use in a bathtub?
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Nope. Name came about b/c the drug comes in a coarse crystalline form and superficially resembles other substances.
 
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From my experience if they mix either k12 or bath salts with either alcohol or weed they can deteriorate quick for no apparent reason and come out of it just as fast. Definitely wierd. Just pay attention to the respiratory drive like all ODs and safety ofcourse
 
Best case scenario had a woman who thought she was a dog walking around on all 4's. A little versed, 12 lead, 02, and supportive care did her good. I've also had a 17 year old that did k2 was unresponsive and presented as stroke. RSI, 12 lead, two IV's, and rapid transport. Ended up having a massive stroke from the K2 and had to take a fixed wing back home since he was only visiting....
 
Support ABCs.. soft restraints and versed as needed.
 
DT4EMS said:
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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Just curious, what did you do for the 50 year old?
 
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