(inhaling through the nose directly over an opencontainer), “bagging” (holding an open bag orcontainer over the head), or “huffing” (pouring orspraying material on a cloth that is held over the mouthand inhaling through the mouth). These methodsusually use a bag or other container to concentrate andretain the propellant thereby producing a quick “high”for the abuser.Persons who regularly abuse inhalants riskpermanent and severe brain damage and even suddendeath. The vapors from these volatile chemicals canreact with the fatty tissues in the brain and literallydissolve them. Additionally, inhalants can reduce theavailability and use of oxygen. Acute and chronicdamage may also occur to the heart, kidneys, liver,peripheral nervous system, bone marrow, and otherorgans. Sudden death can occur from respiratory arrestor irregular heart rhythms that are often difficult totreat even if medical care is quickly available.Signs and symptoms of inhalant abuse closelyresemble a combination of alcohol and marijuanaintoxication. Acute symptoms are very short-lived andare completely gone within two hours. Physicalsymptoms of withdrawal from inhalants includehallucinations, nausea, excessive sweating, handtremors, muscle cramps, headaches, chills andd 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 fdetoxification is required, and relapse is frequent.HANDLING DRUG-INTOXICATEDPERSONSAs in any emergency medical situation, prioritiesof care must be established. Conditions involvingrespiratory or cardiac failure must receive immediateattention before specific action is directed to the drugabuse symptom. General priorities of care are outlinedbelow:The ABCs + D & E: check for adequacy ofairway, breathing, and circulation, signs ofdrug/chemical (“D”) induced altered mentalstatus, and hidden injuries or contact with apoison revealed by exposing (“E”) parts of thebody covered with clothing or other articles.Watch for shock! Give appropriate treatment.If the victim cannot be aroused, place him on hisside so secretions and vomitus can drain from themouth and not be aspirated into the lungs.All adult patients with an altered mental statusshould receive dextrose after blood sugartesting, thiamine, naloxone, and oxygen.If recommended by the PCC or medical officer,place the patient on a cardiac monitor and/orobtain specimens for comprehensive laboratorywork-up (blood and urine).If recommended by the PCC or medical officer,decontaminate the gut. (This decontaminationshould be accomplished ONLY if the victim isconscious and the drug was RECENTLYTAKEN ORALLY.)Prevent the victim from self-injury while highlyexcited or lacking coordination. Use physicalrestraints only if absolutely necessary (i.e., uponfailure of chemical restraints).Calm and reassure the excited patient by “talkingthem down” in a quiet, relaxed, and sympatheticmanner.Gather materials and information to assist inidentifying and treating the suspected drugproblem. Spoons, paper sacks, eyedroppers,hypodermic needles, and vials are excellentidentification clues.The presence of capsules, pills, drug containers,needle marks (tracks) on the patient’s body, orpaint or other substance around the mouth andnose, are also important findings of substanceabuse.A personal history of drug use from the patient orthose accompanying the patient is veryimportant and may reveal how long the victimhas been abusing drugs, approximate amountstaken, and time between doses. Knowledge ofpast medical problems, including history ofconvulsions (with or without drugs) is alsoimportant.Transport the patient and the materials collectedto a medical treatment facility.Inform MTF personnel and present the materialscollected at the scene upon arrival at the facility.5-21
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