(inhaling through the nose directly over an open container), “bagging” (holding an open bag or container over the head), or “huffing” (pouring or spraying material on a cloth that is held over the mouth and inhaling through the mouth). These methods usually use a bag or other container to concentrate and retain the propellant thereby producing a quick “high” for the abuser. Persons who regularly abuse inhalants risk permanent and severe brain damage and even sudden death. The vapors from these volatile chemicals can react with the fatty tissues in the brain and literally dissolve them. Additionally, inhalants can reduce the availability and use of oxygen. Acute and chronic damage may also occur to the heart, kidneys, liver, peripheral nervous system, bone marrow, and other organs. Sudden death can occur from respiratory arrest or irregular heart rhythms that are often difficult to treat even if medical care is quickly available. Signs and symptoms of inhalant abuse closely resemble a combination of alcohol and marijuana intoxication. Acute symptoms are very short-lived and are completely gone within two hours. Physical symptoms of withdrawal from inhalants include hallucinations, nausea, excessive sweating, hand tremors, muscle cramps, headaches, chills and d e l i r i u m t r e m e n s . T h i r t y t o f o r t y d a y s o f detoxification is required, and relapse is frequent. HANDLING DRUG-INTOXICATED PERSONS As in any emergency medical situation, priorities of care must be established. Conditions involving respiratory or cardiac failure must receive immediate attention before specific action is directed to the drug abuse symptom. General priorities of care are outlined below:  The ABCs + D & E: check for adequacy of airway, breathing, and circulation, signs of drug/chemical (“D”) induced altered mental status, and hidden injuries or contact with a poison revealed by exposing (“E”) parts of the body covered with clothing or other articles. Watch for shock! Give appropriate treatment.  If the victim cannot be aroused, place him on his side so secretions and vomitus can drain from the mouth and not be aspirated into the lungs.  All adult patients with an altered mental status should receive dextrose after blood sugar testing, thiamine, naloxone, and oxygen.  If recommended by the PCC or medical officer, place the patient on a cardiac monitor and/or obtain specimens for comprehensive laboratory work-up (blood and urine).  If recommended by the PCC or medical officer, decontaminate the gut. (This decontamination should be accomplished ONLY if the victim is conscious and the drug was RECENTLY TAKEN ORALLY.)  Prevent the victim from self-injury while highly excited or lacking coordination. Use physical restraints only if absolutely necessary (i.e., upon failure of chemical restraints).  Calm and reassure the excited patient by “talking them down” in a quiet, relaxed, and sympathetic manner.  Gather materials and information to assist in identifying and treating the suspected drug problem. Spoons, paper sacks, eyedroppers, hypodermic needles, and vials are excellent identification clues.  The presence of capsules, pills, drug containers, needle marks (tracks) on the patient’s body, or paint or other substance around the mouth and nose, are also important findings of substance abuse.  A personal history of drug use from the patient or those accompanying the patient is very important and may reveal how long the victim has been abusing drugs, approximate amounts taken, and time between doses. Knowledge of past medical problems, including history of convulsions (with or without drugs) is also important.  Transport the patient and the materials collected to a medical treatment facility.  Inform MTF personnel and present the materials collected at the scene upon arrival at the facility. 5-21