What to do

What to do when someone goes over from –

Depressants – Breathing slowed or stopped

Stimulants – Angina, chest pains, heart attack

Drug Induced Seizures – for seizures that can accompany an overdose…

A complete rundown…

Unfortunately it can be a fact for many drug users that we have experienced both sides of an OD. Recent research has shown that almost 70% of users have overdosed on average three times and almost 86% are present when someone else overdoses. Some people can completely freak out and panic when somebody overdoses, but many cope perfectly well.

 

In issue 2 when we covered OD myths, – or rather what NOT to do when someone OD’s: we highlighted that “most Health Authorities do not insist that the police follow an ambulance to an OD. The police WILL NOT attend unless the paramedics believe there is good reason ie; that violence may be involved. If you are still unsure – it may be better to say when phoning 999 to say:

the person involved has stopped breathing; or has had a suspected heart attack, seizure etc (whichever is accurate)

– and give them the rest of the information when they arrive at the scene. Never become aggressive to the paramedics, they are 99% cool with you if you stay cool with them. Answer questions honestly but without implicating yourself if you’re worried, ie;

“They said they had a shot just a few minutes before they came in the door,” etc

– NEVER EVER withhold info as to what drugs you know or think the persons taken, as it could be lifesaving.

 

When you learn the ABC’s of resuscitation, caring for a casualty won’t be the major freakout you envisioned it to be.

 

Think differently. It can and probably has, happened to most of us, when all we wanted was to get stoned. Let’s stop the deaths of someones friend, brother, sisters parent, child, lover, wife etc. Don’t let another death be a statistic.

 

Overdoses from Central Nervous System (CNS) Depressants – (heroin, alcohol, benzodiazipines, barbituates, methadone and opiates, amongst other ‘downer’ type drugs.)

 

The majority of OD:s are from mixing your drugs. Heroin and Methadone – when mixed with other drugs like, alcohol in particular, benzodiazepines – with over 25 different trade names, ( like; Valium, Temazepam, Rohypnol etc – be sure to check the label if possible), are dead certs for OD’s often because of the ‘bravado’ you get from drinking and pill taking and the added forgetfulness about what you’ve taken . Barbiturates (ie; Seconal, Nembutal etc, are harder to get these days but they are around and produce very serious problems whether injecting them or just getting extreme seizures from developing a habit which can lead to brain damage/death from multiple grand mal seizures). Seizures will be dealt with further on in this article.

If someone’s stopped breathing, you need to remember and administer these life saving procedures.

A is for AIRWAYS open

B is for BREATHE for your casualty

C is for CIRCULATE the blood by chest compression

Oh, and we’ll just add D for DON’T PANIC AND DO A

RUNNER.

 

Artificial ventilation (mouth to mouth/ kiss of life etc) is quick and efficient and should prevent the casualty from deteriorating any further until help arrives. Resuscitation should be continued even if you are in doubt about whether the casualty is being revived.

 

When the person goes over…..

First you need to check the breathing of the casualty. When someone has stopped breathing they will almost certainly be unconscious. In order to check breathing, place your ear above the persons mouth and look along the chest and abdomen. If they are breathing you will see and feel and breaths or chest movements. If breathing is regular then place the person in the recovery position until help arrives or they wake up. Fig 6. Keep checking on them regularly.

Pic1

NOW; if checking to see if the casualty is breathing, pinch their earlobes, put your cheek to their mouth to feel any breaths. If they are breathing 4 or less times a minute – they are in serious trouble. If you have established that the person is not breathing, or not breathing enough, but still has a pulse, you then move on to

The ABC procedure. If there is no breaths and no pulse – move straight to C immediately.

 

A – Opening the persons AIRWAY.

The unconscious persons airway may be blocked or narrowed which would make breathing difficult or impossible. Blocked airways happen for a few reasons; the head may be tilted forward, narrowing the air passage; muscular control in the throat can be lost, allowing the tongue to slip back in the throat – or since reflexes are impaired, saliva or vomit may lie there also, again blocking the airway. Any of these situations can lead to death and your mouth to mouth will not be effective anyway unless you check the airway first.

With an open airway, your casualty may start breathing spontaneously. Many peoples lives are saved by this action alone.

They should then be placed in the recovery position if you’re satisfied the breathing is regular enough.

A-Clearing the AIRWAY

How to clear the airway?

– Place one hand under the neck, the other on the forehead and tilt the head backwards. This extends the neck and opens the air passage.

– Transfer your hand from the neck to push the chin upwards and the tilted jaw will lift the tongue, again clearing the airway.

– Clear the airway of any foreign material like loose teeth, dentures, vomit etc by turning the casualty’s head to the side, hook two fingers together and sweep them through the mouth. Don’t spend to long here though.

Fig 2

Move on to B.

B – BREATHING for the casualty

The air we exhale contains about 16% of oxygen which is easily enough to sustain life. Mouth to mouth ventilation makes it easy to watch the casualty’s lungs for movement – showing that they are filling, and also shows up the changes in skin pallor. Hopefully the skin will move from a bluey/grey colour back to a more normal colour. It is easiest to carry this all out when the casualty is on their back but it should be started immediately no matter what position.

How?

1- So, kneeling alongside the chest area, with the head turned back to the tilted back position, block the persons nostrils with two fingers and open your mouth wide – take a deep breath and seal your lips around their mouth.

Fig 3

2- Looking along the chest, blow into the casualty’s lungs until you can see the chest rise to maximum expansion.

Fig 4

3- Move your mouth well away from the casualty and breathe out any excess air. Watch the chest fall and take in a fresh breath. Repeat inflation.

Give the first 4 inflations as quickly as possible without waiting for complete lung deflation between breaths.

Fig 5

4- Check the casualty’s pulse to make sure the heart is beating. This must be checked now and after every three minutes until the person resumes breathing normally, If the heart is not beating now – go straight to C and chest compressions.

You check for a pulse by placing you hand around the hollow in the front of the neck (between the voicebox and adjoining muscle). The wrist is unreliable in this instance so use the neck/throat area.

5- If the heart is beating normally, continue to give inflations at a normal breathing rate – 16-18 times per minute until natural breathing is restored. Then place them in the recovery position.

 

recovery position

That’s all there is to it. You just continue mouth to mouth and checking the pulse every 3 minutes.

C – Assisting the casualty’s CIRCULATION

If mouth to mouth alone is unsuccessful and the heart does not continue beating, you must perform –

External Chest Compression in conjunction with mouth to mouth ventilation.

NEVER START CHEST COMPRESSIONS EVEN IF THE HEART IS BEATING EVER SO FAINTLY.

Without the heart to CIRCULATE the blood, oxygenated blood cannot reach the casualty’s brain. Some people may avoid this procedure because they may be unsure of where to apply the pressure and fear breaking the persons ribs – which can happen if done incorrectly. But remember the person in cardiac arrest is already clinically dead. CPR can only help. Even if it’s not done “letter perfect” it will probably provide some benefit to the victim. Better to have a broken rib or two than be dead.

Have a go – practice (pretend style) on your mate or lover and – who is it that says – BE PREPARED? – Oh yeah, it’s us users innit! Well, here’s how to perform it.

HOW?

Click here for a rundown on Cardio Pulmonary Resusitation (CPR) with pictures.

1) Lay the person on their back on a firm surface. Kneel alongside their chest – in line with the heart. Locate the Lower half of the breastbone; find the sternal notch at the top and the intersection of the rib margins at the bottom. Then place your thumbs midway between these two landmarks to find the centre. This is the spot to work on.

2) Place the heel of one hand on the centre of the lower half of the breastbone, keeping your fingers OFF the ribs. Cover this hand with the heel of your other hand and lock your fingers together.

 

3) Keep your arms straight and move forward until they are vertical (see pic 9). Press down on the lower half of the breastbone (it’s about 11/2 to 2 inches in a normal adult). Move backwards to release pressure. Complete 15 compressions (at a rate of 80 compressions a minute). To find the right rate count aloud. Obviously the rate will be a little faster than 1 a second. Check the face colour and pulse after the first minute.

4) After the 15 compressions and the first pulse check, move back to the casualty’s head and re – open airway (the head should remain tilted back throughout). Give two breaths of mouth to mouth ventilation. See Fig 1-5.

5) Continue with 15 chest compressions again followed by two full ventilations. Check heartbeat every 3 minutes or 12 cycles of compression/mouth to mouth.

 

AS SOON AS A HEARTBEAT RETURNS – STOP COMPRESSIONS IMMEDIATELY.

Continue mouth to mouth alone then, until normal breath returns to the person. They may need casual assistance too breathe, so give it to them when necessary until help arrives. Place in recovery position (Fig 6) when satisfied that they are breathing normally.

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Drug Induced Seizures

 

Epileptic seizures can be very frightening to experience and witness. There are many old myths that still abound concerning how to deal with a person who is fitting (look at OD Myths’ in Black Poppy 2). Many drug users may have experienced a seizure at one time or another – you don’t have to be an epileptic to have a seizure. There are two main types of epileptic seizures; petit mal (minor epilepsy where a person may momentarily lapse into inattention/ daydreaming without losing consciousness) and Grand Mal ( Major epilepsy) which is more serious with muscular spasms and convulsions and a short loss of consciousness. People who are epileptic may often carry an orange ID card or wear a warning bracelet. With drug use, it is the major type of seizure that occurs most often. This is usually from long term (or heavy bingeing) benzo or barbiturate use. A person may miss taking their pills for a day and find themselves fitting. Seizures can occur alongside an overdose on most drugs, indeed they occur from too much alcohol, heroin, cocaine, ecstasy, antidepressants and many others. Everyone has what is known as a ‘seizure threshold’ meaning that anyone can experience on given the right conditions. (BP has an indepth article on seizures, see Issue 11 for our drug induced seizure update.)

It can still happen for up to a few years after benzo/barb use has stopped. It is certain that stress increases the possibility of seizures, as does menstral changes, vitamin or mineral deficiencies, metabolic changes, virus activity and other things, re-occurring if someone has had seizures in the past.

It is ESSENTIAL to remain calm when a person has a seizure -as they can often become very frightened and confused when regaining consciousness and may not recognize their surroundings. There is often no indication prior to someone having a fit, perhaps the person may get an odd taste or smell or a type of ‘aura’ surrounding their mood or body. A person will usually just suddenly lose consciousness, sometimes letting out a strange cry, or will just pass into unconsciousness and then begin fitting.

The casualty will become rigid for a few seconds and may cease breathing with their mouth and lips turning blue. There will be congestion around the face and neck. The muscles then relax and the convulsions begin. They consist of contraction and relaxation of alternate groups of muscles. These convulsions can be frightening to witness as they can be very intense. During this period which will only last a few minutes, the person may froth about the mouth (fig 10) and breathing can become noisy and difficult. You may see blood conning from their mouth but this will probably be the result of a bitten tongue. Your pal may sometimes lose control of their bladder or bowels.

After the convulsions finish (usually 5 minutes at most) the person will remain unconscious for a few more minutes or more, breathing will become normal and they will slowly ‘come around’ feeling dazed, confused and often scared. When a person has a seizure:

When Someone Has a Seizure

1) You can protect them from injury by holding them gently but firmly enough so they don’t hurt themselves whilst convulsing, but never hold them unnecessarily, you could do damage or you may get hurt.

2) Don’t move or lift them unless they are in danger and NEVER put anything in their mouth or try to open it. Spoons to stop people swallowing tongues are a MYTH, DONT DO IT!

3) When the convulsions cease, put them in the recovery position (see fig 6). Stay with them until they awake properly, speak calmly and reassuringly to them and try to make sure the first person they see is a loved one or friend rather than a stranger. Don’t give them anything to drink until they are fully awake. Leave them to rest as long as they need to in a quiet room. It is extremely exhausting for the body. You may need to comence mouth to mouth if their breathing hasn’t returned to normal from their overdose.

Call an ambulance if:

It is the persons first seizure,

Or it accompanies an overdose,

Or the person has two or three fits without regaining consciousness between them,

Or they take longer than 15 minutes to regain consciousness.

It is always important however, they advise their doctor about the seizure, at least to rule out any other causes such as a virus, tumor or other problem.

 

 

Cocaine and Stimulants

 

Heart Problems: This is a condition one may be seeing more of these days – heart giving out from to much Goddamn coke/crack. Sometimes, with the stimulants, it can feel like you’re having a heart attack and God knows we’ve all been there. But with someone speaking calmly and slowly to you, trying to relax you and helping refrain everyone from the additional panic, can do wonders sometimes and ‘bring down’ those who could totally freak out or pass out.

Angina Pectoris can be mistaken for a heart attack as it is a similar feeling in the chest and can be brought about by to much stimulant type drugs. Normally these attacks will only last a few minutes and the pain will stop if you rest and calm yourself as much as you can. The signs are pain in the chest spreading down the shoulder to the arm and fingers (even the throat and across to the other arm). Skin may become ashen and lips blue, one feels short of breath and generally weak. The aim here is to calm the person and place them in a position where the heart is able to work most effectively.

 

1) Help the casualty to sit down. Support this position by placing a jacket or blanket behind them and add padding under the knees.

2) Reassure the person and loosen clothing around their neck, chest and waist. If the symptoms persist and/or worsen, an ambulance will be necessary.

 

Heart Attacks can occur for similar reasons – usually to many stimulant drugs which can cause great strain on the heart or stop the heart altogether {cardiac arrest). OR it may occur with someone who has Deep Vein Thrombosis where a clot may break off, travel to the heart and obstruct a coronary heart muscle (coronary obstruction/ thrombosis). Both these can have serious consequences.

Symptoms are a crushing, vice like pain in the centre of the chest (sometimes described as severe indigestion) which may spread to the throat, arms, jaw or back. Dizziness, ashen face and lips, profuse sweating, breathlessness, irregular pulse and unconsciousness, may develop. Fig 11

1) If conscious, gently support and place casualty in a half sitting position with head and shoulders supported and knees bent. DO NOT allow the casualty to move.

Ring an ambulance immediately.

2) Loosen any clothing around waist, chest and neck.

3) If breathing stops begin resuscitation immediately, going through the steps outlined on the previous pages.

4) If the person becomes unconscious but is breathing normally, place them in the recovery position while you await the ambulance.

 

NOTE; If you need to drive them to hospital then be sure they maintain their treatment position – but only drive them if you cannot get an ambulance quickly.

 

A CARDIAC ARREST will mean the person becomes unconscious and breathing and heartbeat will stop. No pulse will be felt at neck. Commence resuscitation immediately (click to see how) and call ambulance telling them of a suspected heart attack.

 

STAY COOL & CALM & ALWAYS TRY AND KEEP YOUR MATES ALIVE. LEARN THE LANGUAGE OF SURVIVAL.

Remember, if someone does die, you are entitled to mourn and grieve just like everyone else, just because it was an overdose dosent mean you aren’t allowed to be a part of remembering, celebrating and mourning their life & loss.

TAKEN FROM BP ISSUE 4