What Kids are Doing to Get High: Part 1

You and your partner are dispatched for two male patients who have altered levels of consciousness on a local college campus. Dispatch doesn’t have much more information than that, other than PD is already on scene and it is secure.

You arrive to find a group of college-age kids standing in the lobby of a large dormitory. You are escorted to a back hall where PD is questioning a young woman; she is crying and begs you to save her boyfriend. You step into a dorm room that looks like a typical one with a set of bunk beds, two desks with computers, a mini-fridge and empty alcohol containers on the floor. Sitting in a desk chair is a young man who has a metallic gold color surrounding his mouth and nose. He makes eye contact with you and gives a nod. Your partner administers oxygen and begins to get a set of vital signs.

The second patient is another young man who is lying on the bottom bunk. He opens his eyes to a sternal rub and moans briefly. His airway is clear, he is breathing at 28 times per minute and his radial pulse is 140.  As you apply a non-rebreather you overhear what the girlfriend is telling the police officer: in celebrating the end of their first semester at college, a group of kids decided to try some “dex” and spray paint to get a nice buzz before leaving the next morning for their parents’ homes for the holiday break. 

As you get ready to establish an IV in your patient, he opens his eyes, sees the police officer and begins swinging his arms and kicking you away from the bed, screaming something about the “Feds” coming to take him away and how he will lose his scholarship.

What is “dex,” and are your assessment findings typical of this drug?   What is it with the gold coloring on the first patient’s face? Is there anything else you can do to help your patients other than supportive care?

In this series, we will review several of the most popular substances being used specifically by teens today that are easily accessible due their availability at the local convenience or retail store without a prescription. Keep in mind that the availability of a few of the substances that will be mentioned varies based on state law. However, regardless of where you live or work, you should be aware of what kids are doing these days to get high.

Inhalants/Huffing

(Paint thinner, starter fluid, Freon, white-out, compressed air for electronics, certain glues and aerosol products such as room freshener and spray paint)

Method of Abuse: inhalation

Availability: home improvement stores, hardware stores, “Big Box” stores, office supply stores

Volatile solvents are either sniffed directly from the container or dribbled into a napkin and placed over the nose and mouth and inhaled deeply. While aerosols such as spray paint create an effective high, it is reported that metallic spray paint creates the best high, probably due to the amount of benzene they contain.¹  The easiest way to “administer” the spray paint is to spray it into a large plastic bag and then fit the bag tightly over the nose and mouth, and inhale. A euphoric high is initially achieved through the hypoxia that occurs, since the oxygen we should be breathing is being replaced with the propellant from the aerosol can.^2,3 A telltale sign of someone who has recently huffed spray paint is the metallic mask noted around the nose and mouth.² Some may have a strong odor to their breath.⁴

Room deodorizers are often abused due to the sexual enhancement they create, as opposed to euphoria.² This is due to the nitrates that are found in room deodorizers.

Immediate effects of huffing are dizziness, paresthesia, tachypnea, confusion, slurred speech and poor coordination.² Long term effects of huffing include depression, chronic muscle ataxia and irreversible brain and lung damage. ⁵ Although sales of inhalants are prohibited to anyone under the age of 18, minors don’t usually have a problem finding someone over 18 to buy these items for a cash incentive. High-flow oxygen will alleviate part of the disorientation caused by hypoxia.⁶

…As you are treating the young man who is agitated, the young woman comes running in to the room and goes to his bedside, trying to convince him that you and your partner are there to help him and that his scholarship isn’t at risk. The young man settles down but refuses the IV.   He will allow a nasal cannula to be applied but nothing to cover his face, such as a non-rebreather. The woman sits at his side, holding his hand, and appears to have a calming effect on him. He is awake and talking to her and complains of feeling shaky and “hazy.” 

Your partner assists the first patient to the bench seat of the ambulance, secures him, gets another set of vital signs and repeats his assessment. 

You are able to convince the second young man that he needs to be evaluated by a physician, and he agrees to go as long as his girlfriend can accompany him. You agree that the young woman can ride along since she remains calm and cooperative. Before you leave the scene, your partner reports to you that the first patient is cooperative, alert and oriented, and admits to huffing spray paint but denies any other recreational drug use. He has a non-rebreather with high flow oxygen and his vital signs are stable. He answers questions appropriately and says he had a headache but that it has started to go away since the oxygen was applied. As you begin transport, your partner tells you it will be 30 minutes to the nearest facility, as traffic is heavy at this time of the evening.

The second patient is lying on the cot with the nasal cannula in place.  After talking with him for a few minutes, you are able to convince him that you aren’t the police and that you are there to help him. He agrees to allow you to put him on the monitor and start an IV. The monitor shows sinus tachycardia at a rate of 120. When asked what he took this evening, his girlfriend volunteers that he drank a 4-ounce bottle of Vicks Formula 44 cough syrup. You are able to gain IV access and give a fluid bolus, and you call ahead to the receiving facility. Medical Control is made aware of the two patients you are bringing in and offers no additional orders at this time.

You arrive and give report to the receiving ER team. No changes in assessment are noted at the time of transfer of care.  

When you follow up with the ER staff the next day, they tell you that the two young men were treated and released from the ER to the care of their parents, who were called to come and pick them up. The young men admitted experimenting with the substances after hearing from upper classmen that it was “worth the ‘trip.’” Both of the men were embarrassed and said they didn’t want to do anything like that again. 

References

1. Paint Inhalation. Taimapedia, www.taimapedia.org.

2. Inhalant Abuse Prevention Program. Alliance for Consumer Education, www.Inhalant.org. 

3. Intelligence Brief: Huffing--The Abuse of Inhalants. National Drug Intelligence Center, www.justice.gov.

4. Huffing (Inhalants). Adolescent Substance Abuse Prevention, Inc., www.asaprc.org.   

5. Stoppler MC. Is your Child or Teen “Huffing”? MedicineNet, www.medicinenet.com. 

6. Owens G. Police: Stolen Freon was used for huffing. WRAL,  www.wral.com. 

Janet Taylor has been a nurse for over 17 years. She began her career working on a medical-surgical unit and floating to various other departments, gaining knowledge and experience along the way. After working for 7 years in the ICU, obstetrics, outpatient and ER,  Janet began working as a flight nurse for Mercy Life Line in 2004 and helping in EMS education as an Instructor for all levels of classes including basic, advanced and critical care.

Janet serves as the site coordinator for International Trauma Life Support at Citizens Memorial Hospital and also serves as support staff as a Pediatric Advanced Life Support Instructor. She completed her Bachelors Degree in Science and Nursing in May of 2013. Visit her website at www.emsteacher.com.