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The speaker discusses various hallucinogenic substances such as ketamine, LSD, mushrooms, and nutmeg. They also talk about the effects and dangers of overdosing on anticholinergics and cholinergics. They mention the importance of not exposing oneself to these chemicals and the use of atropine as an antidote. The speaker also mentions the possibility of these topics being on an upcoming exam. And they get high protein. Taking a full bottle of that will produce hallucinogenic effects. As a matter of fact, if you take dextromethorphan and Robitussin D and take another dose before the four hours, you'll feel it. You'll start seeing funny things, believe me, I know. But dimethyltryptamine, that is a form of tricyclic antidepressant. Tricyclic antidepressants will produce hallucinogenic effects in high doses. Ketamine, we actually carry ketamine at MedStar now. Ketamine is very popular because it doesn't have the vasoactive or vasoreactive reaction. So it doesn't produce hypodension. It doesn't affect the circulatory system, but it produces the sedation. It's very good for kids. It's a great sedative for kids. My father used to say that, because my father had cardiac issues, so when anyone called for a cardiac procedure, they'd give him ketamine. And he said it was like being in Minecraft. My father didn't know what that Minecraft was, but he said everything was blocked. He looked at everything. Everything was blocked. LSD, we talked about that. Mescaline, which is peyote, used by Native Americans. Morning Glory, nothing. Anybody cook? Cook with nutmeg? Apple pie? Oh yeah, nutmeg. Not the powder that's ground up, but if you took the nutmeg root and you chewed on it, it would have hallucinogenic effects. PCP, psilocybin or mushrooms, this is actually becoming the buzzword. I have a feeling that within the next few years, mushrooms will be legal in Massachusetts. They're finding that it has a medical value now. High doses of mushrooms actually have a positive effect on patients with bipolar and mood disorders. So you may see a, you'll probably see this in the next couple of years, this will become medical grade. You'll be able to get it by prescription from your doctor, and then after that, you'll be able to get it probably. Isn't there a valid question on it this November, that I'm remembering that wrong? Yeah, but it's a valid question. Is that for medical or is that for private use? I know, yes, you're right. There is one coming out. I thought it was for medical use, but it might be private use. It might be in November. It might be coming out. Read the red book. Yeah, I've got the red book at home. I'll read it. I remember that was it. I think that's on like whatever platform I've been watching for micro dosing stuff. Yeah, and it works. It works. So you might see that, so that's something else we may have to deal with. And then salvia. Salvia is a plant that gives a form of high like marijuana. So hallucinogens will cause visual hallucinations, intensify vision and hearing. It does give a heightened hearing. Generally, separate the user from reality. Now, I recommend that you don't feed into their hallucination. If they tell you, don't say, yeah, I see it. Because then they could go, well, I didn't see one. You're lying to me. I don't trust you anymore. So don't feed into their trip. Say, well, I believe you see it, but let's talk about what we need to do. Redirect them. Right? Patients experiencing bad trip will have hypertension, tachycardia, anxiety, paranoia, seizure, coma, death. So use a calm, professional manner. Provide emotional support. You need to let them know that you're in charge without saying, hey, I'm in charge. Redirect them. Right? Do not use restraints unless the patient is in danger of injury. That will just rile them up more. Watch the patient carefully throughout transport. Never leave them unattended. Call ALS if you need, maybe you just need assistance to restrain them, or maybe you need chemical restraint. Anticholinergenics. So these are opposite of the organophosphates, opposite of the nerve agents, opposite of the acetylcholine response. They have properties that block the parasympathetic nerve, so they call it a parasympatholytic. Diphenhydramine, doxamines, suconate, doxamines, suconate. So overdosing on those is a general, is a true emergency. And these are the signs and symptoms you'll get. Hot as a hare, you're going to get hyperthermic. Blind as a bat, your pupils are going to dilate, you're going to have a hard time focusing. Dry as a bone, it's going to clear up and dry up all your secretions. Red as a beet, you're going to get flushed because of the hyperthermia. And mad as a hatter, you're going to be confused. You might have, you might have, what do they call it? You're going to have chronic reactions. Your muscles are going to be too tense and they're going to quiver and tremulous. Common types of drugs are atropine, Benadryl, gypsumene, and amitriptyline. Amitriptyline, again, is another tricyclic antidepressant. And again, these patients can go from healthy to seizure coma death within 30 minutes of an overdose. Usually things like Benadryl, overdoses of over 200 milligrams. So that's, you know, your average, your average Benadryl, adult Benadryl comes in 25 milligram tablets. So you'd have to take like eight tablets in one shot in order to begin to have a toxic effect. That's a lot of tablets. So that's a high therapeutic index. Nobody takes eight pills by mistake, put it that way. Death from these agents can be rapid. So transport immediately, call ALS. We can give the patient medications to kind of slow them down. And we can also sedate them and intubate them if necessary. Cholinergenics. This is the opposite of an anticholinergenic. This stimulates acetylcholine. And there are two things. You can either stimulate the release of acetylcholine or you can inhibit the acetylcholinesterase. They're called esterase inhibitors. Either one is going to leave more acetylcholine on the nerve synapses, overtaking the sympathetic side and causing the sludge them and dumbbells pneumonic. Nerve gasses designed for chemical warfare. Probably never going to run into that. And if you do, you're going to have the ABC of government agencies, you know, the alphabet suit of government agencies, men in black suits there well before you get there, hopefully. But organophosphates you very well could run into. You could get the call from the unresponsive and you arrive, the 80-year-old woman says, yeah, I got the pest guy in the basement because I saw bugs. And he's been down there a half an hour now and I got a terrible smell coming from the basement and I haven't heard him. And I called to him. I said, okay, ma'am, let's get out of the house and you call Hazmat and they'll come in a full SCBA Hazmat suit and they go downstairs and they find the guy lying on the ground, tremulous, drooling, defecated, and blue. Right? Because he overdosed on his own drug. So, we talked about the sludge dump. This is the dumbbell. It's basically the same thing. Diarrhea, urination, meiosis, slash, muscle fascidulation or muscle twitching. Right? Bradycardia, which is slow heart rate. Bronchospasms, which is the constriction of the bronchioles. And then bronchorrhea, the bronchorrhea is increased mucus. You fill up with fluid in your lungs. Emesis, which is vomiting. Lacrimation, which is tearing. And then seizures, salivation, and sweating. So, I don't know. So, I'm thinking that there's a possibility that on the exam next Thursday, whatever it is. Is it this Thursday? What is that? This Thursday. Is it this? Oh yeah, it's this Thursday. So, I'm thinking the possibility this Thursday maybe there's an extra credit that might be sludge and slash dumbbells and if you give me both you get two points. Maybe. Maybe not. I don't know. Salivation, sweating, lacrimation, urination, defecation, drooling, diarrhea, gas or upset, and cramps, emesis, and muscle twitching. It is in the book to get to know me. Cholinergic agents, the most important consideration is to avoid exposing yourself. We don't want any of you exposing yourselves. Get it? That's a joke. Maybe you didn't get it. I don't know. It was meant to be a joke. Anyway, you don't want to become exposed to the chemical. That's the most important thing. So, make sure it's safe. If you believe that there's a chemical out there, many of these chemicals, these organophosphates, are based in oil so that they're non-volatile. They last a long time. They stick on a surface and hold on skin that's absorbed in the skin. You don't want to get these chemicals on you because the oils will allow it to absorb in your skin. So, after decontamination, decrease the secretions in the mouth and trachea, you want to suction, ventilate, and transport. Call ALS. We can give the patient atropine, which is an antidote to this. It reverses the sludge of your lungs. Right? When I was in the Army, we used to have the Mark I kits. The Mark I kits came in a case that was on your belt, and you opened it up, and it had two auto-injectors. It had atropine and 2-PAM chloride, called oxygen chloride. The atropine reversed the anticholinergic effects. The 2-PAM chloride dried up secretions, that bronchorrhea, and then they used to have another one that was Kana, which is convulsive antidote. It was Valium, and you hit that if the patient had seizures. So, we would carry a set, and they were for us. We carried these on the ambulance because after 9-11, the Department of Homeland Security was instituted, and federal money was sent all over the country for use by local EMS and county EMS and state EMS agencies to prepare for, God forbid, another terrorist attack. And so, they went around, they used this money, like C-Med in Holden, bought thousands of what we call TAPRA suits. Those are those self-contained suits that we used for Ebola that we never really used. And they had these Mark I kits. The Mark I kits eventually expired. They were very expensive. Since we carried atropine, it was just nobody bought them. But the Mark I kit in the ambulance, you'd carry two kits. Who would they be for? For you and your partner, right? Because if you go down, you can't help the patient. They're not meant for the patient. They're meant for you. Miscellaneous drugs. Examples of fatally ingested poisons. Accidental or intentional overdose of cardiac meds. Things like Cardizem, Diltiazem, Nifedipine, these calcium channel blockers. Just one pill can be fatal in a small child. The child looks at it and says, oh, candy. Grandpa left his candy on the counter. No, Grandpa left his medication. He forgot to take this one. But it can happen. One of the worst things that I have gone to, and I know that they were popular. I don't know if they're popular now, but they were a few years ago. A script party. Do you know what a script party is? Everybody goes in their parent's cabinet and grabs a handful of drugs and then go and put it in a bowl. And then you mix it up in a bowl. Everybody takes a handful and takes it. Good luck finding out what you took when you get there. And there's three pills left in the bowl. And everybody's on the ground in various states of overdose. You must have been to some wild parties. I responded to these. I wasn't asking you to party. All right, all right, all right. Shit, I'm going to do that. I've been to some wild parties, but never script parties. Things like sedative-hypnotics, alprazolam, Xanax, diazepam, which is Xylem, and Zolpidem, which is Ambien. Ambien is very popular because it was a popular sleep medication a few years ago. And these are the ones where the patients would wake up. They have half the fridge. They eat half the fridge at the overnight. Or you'd find them in the 24-hour CVS buying food, and they'd be half asleep. They drove there. Really bad stuff. Calcium channel blockers. Things like Barapimil, Nifedipine, Zolpidem. These are the ones, which is one pill can kill a child. Stimulants, street drugs, opiates. We talked about that. Beta blockers. Metropholol, Atenolol, Levetolol, Stenolol, Inderol. Acetaminophen alone or in combination. Acetaminophen can be found in all kinds of things. Acetaminophen for migraines. You know, I've got a flu. I say I've got the flu, but I also have a migraine. I'm going to take some NyQuil. Then I'm going to take some Acetaminophen for my aches and pains. And then I'll take an Excedrin PM. Well, guess what? They all have Acetaminophen in them. Alcohols. And, you know, you can take ethyl alcohol and you can take wood alcohol or rubbing alcohol. That's actually worse. Ask Kitty Dukakis. She drank wood alcohol. Rubbing alcohol. I had a patient one time that was working with, well, she came in, and this was at Neshoba Hospital. I was in the ER. And she was brought in. She had a glass. This is the way it was explained to me. She had a glass of water and a glass of tape there. I hope it's put there on a glass. But she was in the garage and she was working. It was very hot. It was like 90 degrees. And she chugged what she thought was the water. And after about four or five drinks realized, oh, my God, this is pain thinner. So she got brought in. So things like wood alcohol, rubbing alcohol, pain thinners and things like that. When that breaks down in the body, it produces a chemical called carboxyhemoglobin, which is actually toxic to the body. So the antidote for that is ethyl alcohol. The body has a greater affinity to break down ethyl alcohol than methyl alcohol and things like that. So what it will do is your body will excrete the wood alcohol, the rubbing alcohol, and the body will break down the ethyl alcohol. So you get a 5% IV solution of alcohol. You literally sit there and get a beer. I felt like a bartender. This girl came in. We gave her the IV fluid. And I just was talking to her. I gave her a magazine. Do you want some nuts and chips while you're drinking your beer? And that was the treatment. Antidepressants, things like selectives, serotonin, reuptake inhibitors, SSRIs, such as Zoloft and others. An SSRI, what that does is serotonin, melatonin and paraserotonin affect your reticular activating system. Serotonin is a mood elevator. It wakes you up, among other things. Melatonin puts you to sleep. It's part of our circadian rhythm, our sleep-wake cycle. So if I keep serotonin on the nerve synapses longer, it produces an elevated mood. So it's an antidepressant. And they don't believe that it does. For some people, it really works. But they don't believe the action. They originally gave it for that reason, and they thought it worked. Now they don't believe that it works because of that. Although for some people, it still works. You might also hear a medication called an MAOI inhibitor. It does the same basic thing. Monoamine oxidase removes serotonin. It breaks it down. So if I inhibit monoamine oxidase, I'll keep serotonin on longer. Hyperglycemic drugs. Things like Legovi or what's the other one? Trelegy. What's the big one that's out there they're talking about now? What's the big one they got out there now? They're warning about it. Ozempic. Acetylsalicylic aspirin, which is aspirin or oil of wintergreen, which also has acetylsaline in it. Tricyclic antidepressants, we talked about that. Miscellaneous drug. Cystic symptoms depend upon the drug ingested or the medication ingested. Could anything from sedation to excitation, vomiting, nausea, respiratory depression. Do not call poison control. Call medical control and tell them what you got. If you have a pill and you don't know what it is, take a picture of it. You can search it on Google or take a picture of it and you can send it to the doctor's home and he can look at it and identify what it is. There are programs that you can download on your phone that you take a picture of the pill and it will identify what the medication is. All pills, the FDA approves all medications in their form. So when a company produces a medication, it has a particular type of shape and a marking on it. A letter or a number and a particular shape and a color. And that identifies that particular, no other pill, like you couldn't make Xanax and Zantac with the exact same shape or color. They have to be different. That's one way we can identify it. That's why doctors can identify pills from the vomitus. Because they can look at it and see. Aspirin poisoning remains a potentially lethal condition. Things like nausea, vomiting, hyperventilation and tinnitus or ringing in the ears. What happens is the patients become hyperthermic. Acetylsalicylic acid will cause hyperthermia. They'll have a central neurogenic hyperventilation. It's very deep, rapid respiration. As they're trying to blow off those acids. And it can be fatal. It's a hell of a way to go. Patients will have anxiety, confusion, tachypnea, hyperthermia and seizure coma death. That's one of the outcomes of overdosing on acetylsalicylic acid. So overdosing on acetaminophen is also very common. But you can't overdose by accident. Because it takes 8,000 milligrams in a particular dose, in one dose, to be toxic. That's 16, 500 milligram tablets. That's a lot of friggin' tablets. So you don't make that mistake. That's intentional overdosing. But it's still, you take it, nothing happens until seven days later when you go into liver failure. So the antidote for that is N-acetylcysteine. It's given IV in the ICU. If it's given within three hours of the poisoning, generally the patient will have minimal effect in their liver. That's why time is of the essence in any kind of poisoning situation. We talked about methyl alcohol and ethylene glycol. One of the other things about ethylene glycol, ethylene glycol we find that in antifreeze. And that's why when you do pools, pools have a non-toxic antifreeze. Because ethylene glycol is the number one ingredient in antifreeze. And we see homeless people, alcoholics, and animals die every year, especially come the wintertime, the fall and the winter. Because the antifreezes come out for pools and things. They get a hold of it. It's cheap. It's sweet. So animals like it. And what happens is it crystallizes in the blood and causes damage to the liver and blood vessels. And you end up dying. Food poisoning. Almost always caused by eating food contaminated by bacteria. There are two types. The organism itself that causes the disease, like salmonella. And organisms that produce toxins that cause disease, like sap and streptococcus and botulinum. And let's take a break here. Thank you. Thank you.