Las Vegas EMS Responds to Huffing Patient

 

 
 
 

Bruce Evans, MPA, NREMT-P | From the January 2008 Issue | Friday, May 1, 2009


A crew responds to a non-emergency request by law enforcement for a teenage driver pulled over in an upscale residential neighborhood. Upon arrival, the crew notices a car pulled over on the side of the street with one wheel on the grass, aimed toward the sidewalk. A young male is sitting in the rear of a patrol car in a local computer store uniform. The officer states that the car the young man was driving was witnessed moving slowly and then bouncing off the curb. The officer wants the kid checked out before he takes him to be seen by the jail nurse. The officer has not registered anything in his breathalyzer and suspects the kid has been using prescription medicine, is diabetic or may have had a seizure.

An initial assessment reveals the 19-year-old male to have obviously dilated pupils. He stares at the crew with a blank look, and attempts to question him are met with only "huh" or "what." Although he's awake and alert, he is obviously not in appropriate condition to have been driving.

The patient's vital signs are: HR 132, BP 146/60 and respirations of 20. A finger stick reveals a blood sugar of 105, and his pulse oximetry is 97%. He has a normal temperature to the touch and is warm and dry. The rest of his physical exam is unremarkable. The captain directs the senior firefighter to look in the car. The firefighter returns with six empty cans of Dust-Off found in the back seat of his car. It becomes apparent the patient was huffing, and an ambulance is summoned to transport him.

A cardiac monitor is applied and, while the crew waits for the ambulance, a 12-lead ECG is conducted, showing sinus tachycardia and a prolonged QT.

This patient receives oxygen, has an IV started, and his vitals are reassessed. The ambulance arrives to transport the patient to the hospital.

A week earlier, that same crew responded to a home to another huffing call -- but this time for a teenager deceased with a bag over his head, connected to an empty can of Scotch guard.

Halogenated Hydrocarbon Abuse

Dust-Off is commonly thought of as simply compressed air, but the refrigerant in the can -- 1,1-Difluoroethane -- is toxic to cardiac cells. Abuse of halogenated hydrocarbons has been growing in frequency and, in some communities, has become a serious problem.

Easy access to cleaning fluids, air conditioning products and other industrial, commercial and household chemicals makes huffing easy for people who don't have access to or money for drugs or alcohol.

Spray paint is another commonly abused inhalant, and street folklore touts a better high from the use of gold paint. Elaborate devices employing army surplus gas masks or simply a jury-rigged plastic bag ensure the concentration of the chemical is sufficient to achieve the high. The radical nature of the chemicals immediately attacks the heart muscle, stimulating excitability in the cardiac muscle cell that can lead to ventricular tachycardia.

The other inert ingredients from chemicals in spray cans can lead to non-cardiogenic pulmonary edema or result in a chemical pneumonia. The patient loses consciousness and often falls into a position that occludes their airway or results in suffocation from the device they have used to deliver the gas.

Bruce Evans, MPA, NREMT-P, is the EMS chief of the North Las Vegas Fire Department and the fire-science program coordinator at the College of Southern Nevada. He's also chair of the Health and Safety Committee of the NAEMT, a member of the FESHE steering committee at the NFA and a JEMS editorial board member. Contact him athawkeyeems@aol.com.

Clickhere to read ˙Huffing: What You Need to Know About this Dangerous Trend.Ó




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Related Topics: Patient Care, Medical Emergencies, Patient Management, Jems Features

 

Bruce Evans, MPA, NREMT-PBruce Evans, MPA, NREMT-P, is the EMS chief of the North Las Vegas Fire Department and the fire-science program coordinator at the College of Southern Nevada. He’s also chair of the Health and Safety Committee of the NAEMT, a member of the FESHE steering committee at the NFA and a JEMS editorial board member. Contact him at hawkeyeems@aol.com.

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