1015 fourteen

You may carry a pre-mixed suspension of 50 grams. Again, it's one gram per kilogram up to 50 grams. That's the maximum dose. Before you evacuate charcoal, you have to get medical control approval. And that was across the board in Massachusetts for everybody. Even paramedics needed medical control. Shake the bottle vigorously. Never force the patient to drink it because you want them to drink it. Have them just don't. You know how you drink a soda, you take a sip, you swish it in your mouth, ooh, that tastes good. Don't do that. Take it in the back of your throat, squirt it in, and swallow it. Side effects are constipation and black stools. Makes sense. It's charcoal. If the patient is ingested a poison that causes nausea, they may vomit, which means it's non-memetic. They have to take it again. Specific poisons. Over time, a person routinely misuses a substance may need an increasing amount to achieve the same results. Opiates, you can develop opiate tolerances. Cocaine, you can develop cocaine tolerances. Anything, crystal meth, anything you can develop a tolerance to over time. This is why some patients, I've known patients that take 40 milligrams of oxycodone a day. 40 milligrams and I'd be dead, literally on a ventilator dead. And they take it every day because they've built a tolerance to it. A person with an addiction has an overwhelming need to continue using a substance at whatever cost. A physical and mental addiction, and that's the problem with addictions, is that a lot of people, especially EMS providers that have been this a long time, you get burnout and you kind of like, you get apathetic and you're like, whatever, just quit. You can quit. It's not that simple. And if you don't have an addiction, you don't know. It is a real difficult thing to stop. You've got to have empathy for these people. What is the strongest bond there is in the human being? Mother and child. That maternal bond is the strongest. You can't break that. And I have seen women who are pregnant get heroin from a guy on the street they don't know, and they'll shoot it up with a dirty needle while they're pregnant because they need to get high. If you're willing to do that and risk yours and your child's life, how strong is that addiction? Just think about that when you're dealing with these addicts. Some of these addicts, hey, I've said more than once to an addict, hey, you need to find a new hobby because this is the 23rd time we've narcan'd you. But it's a real difficult thing. So just keep that in mind when you're dealing. Have empathy for these patients. Believe me, nobody wakes up in the morning going, today I want to shoot up and get high and live on the streets. Nobody thinks that way. I'm going to talk about that. Almost any substance can be abused. And it talks about a person with an addiction who has an overwhelming need to continue using the substance. So let's talk about that. How do people become an addict? So we talk about opiates because opiates are probably the most common. So most of your addicts didn't start out waking up one day going, oh, I can't wait to stick myself with a needle. Many of them come across after a legitimate medical condition. They get injured, they hurt their back or whatever, and they take these opiates. And they have more pain, maybe they develop a tolerance, they take it more and more and more. And then what happens is the physical pain that they were taking it for goes away. But now they have a physical addiction and a need and a withdrawal if they don't use it. They start jonesing for the drug, right? You hear that term, jonesing. And so they need it. And so they ask for increasing amounts because of the tolerance is not enough for them. Finally, a doctor will say, okay, look, we've given you enough. You can't physically have this pain anymore. This is in your head. We're gonna cut you back or cut you off. So what does the patient do? Well, they use up all their opiates, pills, and they've got no more left. So then they go to family and friends and they start saying, hey, I really need some. I ran out of my prescription. I gotta go get it filled. Then they'll go to all the people. And then they'll beg, borrow, or steal to get it. Then they start buying it on the street. They find a dealer and they start buying it. And the dealer, for the first few times, will say, hey, you want some pills? Here's the pills and they'll sell them to you. Then he'll say, you know what? I don't have any more pills, but I've got something that's better for you. I've got something you can eject. And the high is 10 times better. And if you ask an addict which is better, pills or injection, they're gonna tell you, hands down, the ejection is 10 times better. It's a stronger high. It's a faster high. So he teaches them how to shoot up. Now they're hooked. And now they're IV drug users. And they'll steal, they'll rob, whatever. And I've known drug dealers that, you know, have, they maintain a job for a little while, but then the addiction gets too great for them because they have to shoot up two or three times a day. And so, at 20, 30 bucks a pop, two or three times a day, it's $100 a day. That's a $700 a week habit, sometimes more than that. That's all your income, right? And if you spend all day looking, you're not gonna be able to work. So that's usually what happens. So, let's talk about the other end, the drug dealer. Drug dealers will go, they buy the drug. They buy so much of it, you know, whether it be, you know, a kilo would be a huge amount, but they buy small amounts, you know, five grams, 10 grams. And what they do is they cut it. They put in a cutting agent. They can use inositol, which is a weight supplement. People that are weightlifting, they use it. But you can use baby powder, baby formula. They use, you know, like I said, inositol. Hell, they use rat poison, down cap, whatever they need to cut it. Because when I spend XYZ dollars on 20 grams, and I turn it into 40 grams, I just double my money. So what they'll do is they'll go out and they'll sell it. You'll buy a gram bag for, you know, 20 bucks or 30 bucks or whatever it is. And then after a period of time, they start to see their supply dwindling. They'll cut it again, and then they'll cut it again. So they weaken that amount by half each time. So by the end of their supply, you used to buy one bag, now you're buying three to get high. But you'll do it, because you want to get high. Now, the new shipment comes in. This is how we know that the new shipment comes in. This is how we know, in EMS and in healthcare, yep, there's a new batch out there. Because what happens is the guy gets his new shipment in, and he cuts it once. It's three times more potent than the last drugs he sold, because he's got a fresh batch. So he goes to you, does he think he saved you? Oh, you only need one bag this time to get high. He says, you know what, last time you had three, you should buy four bags this time. Yeah, yeah, yeah. And you shoot up the four bags, and you overdose and die. Do you think the drug dealer cares about that? Because the drug dealer, because it gets around the neighborhood, you know that drug dealer on the corner? He had a person die on his stuff. He's got the good stuff, let's go buy it from him. That's the way it works. And that's how we know that there's a new batch of stuff out, because we see a whole influx of new overdoses. And that's how we know. Or there's something else out there, we know that. So the importance of safety awareness and state of precautions cannot be overemphasized, especially when you talk about your IV drug users. They can have hepatitis A, B, C, D, E, F, G. They can have a high five, they can get all kinds of different nasty, creepy qualities that you don't want to get. And if they don't care about themselves, are they really going to care about you? Probably not. I've done a lot of overdoses where I've said to the patient, hey, we need to give you an IV, do you have anything that I don't want to get? Oh yeah, I got hepatitis, or I got HIV, or whatever. Patients have told me that, and I appreciate that. But don't count on it, and don't expect them to be honest with you. Be very safe. Be careful with needles, these patients. What do they have? They've got needles, they're in their pocket, they're all over the place. Be very careful when you check these patients. Don't shove your hands in their pockets. Don't put your hand in their backpacks. Be very careful, usually you take two fingers and you empty it out like that. Don't put your hand inside of anything, because you never know what your hand is going to run into. Be very, very careful. Let's take five minutes. Come on, come on, come on, come on, come on, come on, come on. Come on, come on, come on, come on, come on, come on, come on. Come on, come on, come on, come on, come on, come on, come on. Come on, come on, come on, come on, come on, come on, come on. Come on, come on, come on, come on, come on, come on, come on. Come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on, come on. I need to show you that thing. Oh, yeah. You saw it? Yeah. It's a blood clot. Yeah. Pulled out of a bronchial tree. In the shape of? A bronchial tree. Yeah. Yeah, it's insane. That's what happens when blood goes in your airway. I never knew it can have the shape of anything. Oh, yeah, because it's all the way down. But it's rare. I like it a lot. Well, it's... I hear they say it's an anomaly, so... Well, but it can be, that can be anywhere. That can be in your lungs. That can be blood vessels, too. So if someone has a stroke, like an aneurysm in the brain or something like that, can it go in the shape of? Well, now, that... It can, yes, but usually it's a smaller occlusion. It doesn't usually develop like that. But that's what happens when blood blocks. It will clot like that. So, yes, that can happen. More often than not, that is... Bad stuff. Bad stuff. I wish it was one of the white ones. I know. And I did think I'd like them. You didn't like them? I did like them. Oh, they're good. I think I was going to. And then when I tried it, you guys were like, it was so good. They were. Yeah, I liked them. They were my favorite. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.