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Punk’s & DrunksBy: Kane Guthrie
RN SCGH ED
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Is there a problem in WA?Biggest issues in EDAlcoholOverdosesMental Health IssuesHeroinDrug Induced PsychosisRecreational Drug use occasionally
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OverdosesMost CommonParacetamolBenzodiazepinesAntidepressantAntipsychoticsAntiepilepticOpioidsAlcohol most common adjunct
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Assessing the Intoxicated Patient! Obtain the following:1. Pharmaceutical agent or toxin ingested: Two or more drugs are taken in 30% of
cases. Alcohol is a common adjunct.2. Quantity of agent ingested.3. Time since ingestion.4. Hx of toxic effects already experience by
poison.5. Specifics of events prior to arrival:a. Rapid deterioration in conscious level.b. Seizures.
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Assessment Continued:
6. Corroborate the history in cooperative patient, but do not be mislead, as info supplied can be incomplete or deliberately false.
7. Rapidly assess airway patency, respiratory function, and conscious level.
8. Record pulse, BP, RR, Temp, and BSL, pupils, & attach cardiac monitor.
9. Hypoglycaemia and hyperthermia are common findings in collapsed patient with OD, & are commonly overlooked.
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Clues to look out for:Signs of seizure activity, assess motor
function of extremities.Dilated pupils: Tricyclics, amphetamines,
antihistamines, anticholinergics agents.Pinpoint pupils: opiates, organophosphates.Nystagmus: alcohol, benzodiazepines,
phenytoin.Hyperventilation: salcylates.Nasal bleeding: solvent abuse.
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Medical ConditionsSome medical conditions can make casualties
present to us as they are intoxicated, be vigilant for:
Head InjuryDiabetesEpilepsyInfectionPrescribed drug toxicity.
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Why do people take recreational drugs!EuphoriaPeer PressureSocial accepted?To fit inExperimentationLack of understandingRegular use can lead to addiction!!
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AlcoholIs the Bain of emergency departmentsIndicated in 30% of presentations to EDPt’s difficult to assess and find underlying
injuries when intoxicated (esp. Head Injury)Injured pts who are intoxicated have an
increased mortality rate.Chronic use leads to organ damage
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Alcohol Absorption Alcohol is rapidly absorbed from the small
bowel (around 80%), and stomach (around 20%).
Alcohol is water soluble, and little or no alcohol enters fatty tissue.
Reaches brain within 5mins, blood concentration peak between 30 to 90 (Typically 45mins).
Absorption will vary with: Beverage type Presence of food in stomach Individual factors: age, gender, size, drinking
rate, experience.
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Harms of Alcohol Abuse:Most drinkers (73%) generally consume alcohol
in ways considered at low health risk (AIHW, 2002).
Contributes to over 3000 deaths per year.18% of injuries presenting to ED.50% assaults.30% of Car accidents34% of drownings and falls.44% of fire related injuries.Source: (CDHAC, 2001; CDHA, 2002;nhmrc,
2001;APF, 2001; Alcohol and other drugs: A Hand book for Health Professionals).
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Drugs TypesThe Groups:StimulantsDepressantsHallucinogens
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How they effect the body!Have there effect by how they affect the CNSEach drug have different effects on the bodyHard to know what is actually in street drugsToleranceRegular use
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Stimulants
SpeedEcstasy (Most Common)CocaineAmphetamines (Meth, Crystal)
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Amphetamines
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Positive signs of Amphetamines
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Positive signs of Amphetamines
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Types of Amphetamines1.Methamphetamines: Commonly know as
“speed or whiz”. Speed varies in: Texture ( fine
crystallised or coarse powder).
Colour ( white to yellow, brown, orange or pink,
Purity
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Types of Amphetamines2.Crystalmethampheta
mine: Known as Ice, crystal
meth. Has a crushed ice
appearance. Usually smoked, but
can be dissolved in water for injection, can be swallowed or snorted.
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CocaineCocaine is a stimulant derived from the South
American coca plantCocaine is either snorted, smoked,
intravenously administered.Cocaine use produces euphoria, mental
stimulation, and generalised central nervous system stimulation.
Ingestion of 1g or more is potentially lethal.
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EcstasyEcstasy is generally
the street name applied to MDMA.
Used as a stimulant.Common at raves,
night clubsKnown on streets as
soft drug, causes 3-5 deaths each year (WA)
Hyperthermia, water intoxication
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Stimulant Signs and SymptomsIncreased BPIncreased HRIncreased TempIncreased RRPupils dilatedAlert, aroused, agitated, paranoid, AggressiveHeadaches, Can Develop:MI, CVA ,Seizures, Psychosis
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Stimulants ManagementDRABCMonitor Vital SignsLow stimuli environmentMay require security/policeMay need t/f to hospital
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DepressantsAlcoholHeroin (Opiates)GHB Toxicity
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Depressant Signs & SymptomsDecreased Conscious stateDecrease RRMay have Low BP & HRSmall Pupils
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Depressant ManagementDRABCConscious state can deteriorate quicklyMay require respiratory supportArrange transport to hospital? Naloxone use in prehospital environment
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HallucinogensLSD (lysergic acid diethylamide)Magic MushroomsAnticholinergics (datura, angles trumpet)Ketamine (dissociative) Marijuana
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Hallucinogen Signs & SymptomsBizarre thought disordered behaviourVisual or auditory hallucinationsAnxietyIncreased HRImpaired coordinationParanoid
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Hallucinogens ManagementDRABCLow stimuli environmentMay require restraint and sedationConscious state can deteriorate quickly Can develop fast heart rates
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Some end up in ICU
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Drink Spiking WA studyProspective study of 101 patients with
suspected drink spikingPeople who thought there drink had been
spiked encouraged to attend ED (SCGH,JHC)97 alleged cases (88% female)28% had illicit drugs on boardMedium Blood Alcohol was .096Result no detectable sedative found in urine
or blood test
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Difficult BehavioursCan result from D&A use or Mental IllnessViolence & Assault common occurrence in
the community every dayRemain Open and positiveDon’t stereotype or JudgeMaintain your own safetyEveryone has a story let them tell it.
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Violence and AggressionManagement:May require Restraint by police,Rapid sedation Low stimuli environmentPatients generally remember everything that
happens
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WA Poisons Information Centre13 11 26Located next SCGH EDExcellent resource for finding out informationAvailable 24/7
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The End