1. Poison Center Overview
K2 and Bath Salts
New Drugs of Abuse
Sanford Poison Center - Amy Marsh
South Dakota Monthly EMS training Program
South Dakota Department of Public Safety – Office of EMS
January 2012 – Medical Emergencies

2. OBJECTIVES
• Upon completion of this presentation, the
student will be able to identify the four routes of
exposures.
• Upon completion of this presentation, the
student will be to identify the phone number for
the Poison Center- 800-222-1222
• Upon completion of the presentation, the
student will be define the two new drugs of
abuse – K2(Spice) and Bath Salts.

3. Routes of Exposure
• Ingestion
• Inhalation
• Injection
• Absorption

4. Poisoning by Ingestion
• Definition - Item is swallowed or taken in by mouth
• Most common are medications and household
cleaners
• Assessment clues include open bottles, stained
fingers, lips or tongue, or chewed leaves on a plant.
• Ingestion is normally a slow absorption unless it is
caustic and may cause burns to the mouth and lips.

5. Ingestion Poison Emergency Care
• Try to identify product ingested
• Treat any life threatening emergencies such as
breathing difficulties
• Contact Poison Center – 800-222-1222 for
treatment protocol

6. Poisoning by Inhalation
• Definition – Patient has breathed in toxin.
• Most common is Carbon Monoxide
• Ensure your safety and call for special
resources to remove patient if they are still in
the toxic environment.
• Depending on the toxin can rapidly or slowly
enter the body.

7. Inhalation Poison Emergency Care
• Remove patient from toxic environment. This
needs to be done by local Haz-Mat team or
those specifically trained.
• Administer high concentration of Oxygen
• Contact Poison Center – 800-222-1222 for
treatment protocol

8. Poisoning by Injection
• Definition – toxin enters the body through a
puncture caused by a needle, a bite or a sting.
• Most commonly associated with drugs of
abuse such as heroin or cocaine.
• Poison spiders and snakes also cause an
injection poisoning.
• Rapidly absorbed into the body.

9. Injection Poison Emergency Care
• Ensure scene safety
• Contact Poison Center – 800-222-1222 for
treatment protocol

10. Poison by Absorption
• Definition – toxin absorbed through the skin
• Most common toxin is pesticides.
• Avoid contaminating yourself.
• Brush away any drug chemicals and remove
exposed clothing.

11. Absorption Poison Emergency Care
• Avoid contaminating yourself.
• Brush away any drug chemicals and remove
exposed clothing.
• Contact Poison Center – 800-222-1222 for
treatment protocol

12. Poison Control Center – 800-222-1222
• Sanford Poison Center calls are answered by
Hennepin Poison Center at the Hennepin Regional
Medical Center in Minneapolis, MN.
• Hennepin Poison Center answers over 60,000 calls
year.
• The center is available 24 hours a day, 7 days a week.
• Program the phone number into your cell phone for
easy access on an emergency call.

13. Role of the Poison Center
• To provide 24/7 emergent and non-emergent
medical assessment, triage and treatment
recommendations for all poisonings
• Service provided to public, pre-hospital
personnel and health care professionals
• Telephone based service with a single national
telephone number

14. K2 - Definition
• A popular mixture of herbs and spice that are
sprayed with a psychoactive chemical and sold
as a legal marijuana substitute in shops and
via internet.
• Other names include Spice, Genie, Yucatan
Fire, King Krypto, Mr. Nice Guy and Super
Skunk
• Chemical name – JWH-015, JWH-018

15. K2 Nationwide Use
• All U.S. Poison Center Data 2010 – 2,915 calls
regarding K2-Spice
• All U.S. Poison Center Data 2011 – 6,348 total
calls regarding K2-Spice

16. K2 and South Dakota Abuse
• Sanford Poison Center Data 2010 – 4 calls
regarding K2-Spice
• Sanford Poison Center Data 2011 – 27 total
calls – 22 exposures and 5 request for
information calls

17. K2 – Signs and Symptoms of Use
• Marijuana like effects
– Red Eyes
– Pale Skin
– Slow speech
– Lethargic movements

18. K2 – Signs and Symptoms of High
Dose or Bad Reaction
• Agitation
• Anxiety
• Tachycardia
• Hypertension
• Vomiting
• Hallucinations

19. K2 – Why are they using?
• Obtained legally in many states
• Easy to purchase – head shops and on the
internet
• Looks like potpourri

20. K2 – Emergency Care
• Call the poison center at 800-222-1222 for
assistance in care.
• Treat symptoms as normal – High Flow
Oxygen, etc.
• Obtain Law Enforcement assistance as they
could be potentially dangerous due to the
hallucination effects.

21. Bath Salts - Definition
• The substance in question is being marketed as a
bath salt but is actually white powder, a chemical
composition that is snorted or ingested, inducing
pharmacological effects similar to those obtained
through cocaine. The chemicals, mephedrone and
MDPV, cause dangerous side effects that include
severe hallucinations. Named bath salts for it’s
appearance, not their intended use.

22. Bath Salts Nationwide Use
• All U.S. Poison Center Data 2010 – 303 calls
regarding Bath Salts
• All U.S. Poison Center Data 2011 – 5,853 total
calls regarding Bath Salts

23. Bath Salts and South Dakota use
• Sanford Poison Center Data 2010 – zero calls
regarding Bath Salts.
• Sanford Poison Center Data 2011 – 21 total
calls with 18 exposure calls and 3 request for
information calls.

24. Bath Salts – Common Use
• Packaged with labeling of “not for human
consumption.”
• Most patients have reported snorting the
product.

25. Bath Salts – Common Names
• Red Dove
• Blue Silk
• Zoom
• Snow
• Ivory
• Hurricane Charlie
• Night Light

26. Bath Salts – Symptoms of Abuse
• Increased Blood Pressure
• Increased and Irregular Heart Rate – Chest Pain
• Agitation – more assertive behavior than normal
• Hallucinations
• Extreme Paranoia
• Shaking/Trembling hands - Seizures
• Delusions – Complete break with Reality

27. Bath Salts – Long Term Affects
• Permanent Physical disabilities
• Permanent Mental injuries
• Death

28. Bath Salts – Emergency Care
• First and Foremost – Personal Safety – these
individuals are at high risk of hurting
themselves and others around them.
• Call the poison center at 1-800-222-1222 for
assistance in care.
• Treat symptoms as normal
• Obtain Law Enforcement assistance

29. South Dakota Law
State of South Dakota – 2011 Legislative Session
- Senate Bill 34
“Any person who possesses, possesses with
intent to distribute, sells or distribute a
substance knowing that it is to be used in
violation of SDCL 22-42-15 is guilty of a Class 1
misdemeanor.”

30. How You Can Help
• Pass the Word!
• Be Role Models.
• Provide Prevention Education.
Many resources available.
www.sdpoison.org

31. If you think it’s a poison,
what do you do?
Dial 1-800-222-1222

32. Real Case Studies
• Case 739 – 17 year old patient arrived in ER
with a history of seizures. Patient admitted to
using “posh” – another name for K2. Patient
had additional seizure while in the intensive
care unit. Patient was tachycardic, agitated
and confused.

33. Outcome
• Patient was monitored overnight and was
discharged the next day. Continued to report
paranoia for additional 48 hours.

34. Real Case Studies
• Case 1809 – 19 year old patient arrived in ER
with muscle twitching progressing to muscle
stiffness, dilated pupils and rapid eye
movement. Patient admitted to using “Night
Light” –name for Bath Salts. Patient HR = 181,
RR=36, BP 140/56. Pt received high flow
oxygen, fluids and benzodiazepines.

35. Outcome
• Patient was monitored for 24 hours and
physical symptoms relieved. Pt transferred to
inpatient mental health. Patient continued in
the mental health facility for seven days until
hallucinating had stopped.

36. Scenario
• Dispatched to a suicidal patient. Patient
admits to smoking K2 approximately one hour
ago.

37. Patient Assessment
• Scene Size-Up
– Ensure law enforcement has secured the scene.
– No spinal precautions needed patient is threatening suicide
• Primary Survey
– General Impression – patient is anxious and paranoid. LOC – altered
– Airway – open and clear, RR – 24
– Circulation – HR – 100, no bleeding, skin warm to the touch.
– Transport decision - ?
• History Taking
– pt admits to taking a product named Spice. Onset of rapid heart rate,
anxiety and paranoia. Pt states he is considering suicide. No past
medical Hx noted. When do you contact the Poison Center?

38. Patient Assessment (con’t)
• Secondary Assessment – Psychological/Social
• Vital Signs
– Pulse – 100, RR – 24 and regular, BP – 140/90
– Field Impression - ?
– Interventions - ?
• Reassessment

39. Scenario
• Dispatched to the local school for a patient
who is threatening staff with a knife. It has
been identified by another student that the
patient had just snorted a product call Night
Light.

40. Patient Assessment
• Scene Size-Up
– Ensure law enforcement has secured the scene.
– No spinal precautions needed patient is a threat to self and others
• Primary Survey
– General Impression – patient is anxious and paranoid. LOC – altered
– Airway – open and clear, breathing very fast
– Circulation – tachycardic, no bleeding, skin very warm to the touch.
– Transport decision - ?
• History Taking
– Pt was seen snorting a product named Night Light (bath salts). Onset
of rapid heart rate, anxiety and paranoia. Pt is unable to control
actions. Restraints need to be considered. No past medical Hx noted.
When do you contact the Poison Center?

41. Patient Assessment (con’t)
• Secondary Assessment – Psychological/Social
• Vital Signs
– Pulse – 140, RR – 32 and regular, BP – 140/90
– Field Impression - ?
– Interventions - ?
• Reassessment
• ALS intercept for IV and drug administration.

42. Further Information
• Amy Marsh, Poison Control Educator
• Sanford Poison Control Center
• 605-328-6668
• amy.marsh@sanfordhealth.org