GHB

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GHB

  1. 1. What the emergency nurse need’s to know about GHB?
  2. 2. GHB Culture  Popular @rave parties for euphoric effects  Bodybuilder Supplement (growth hormone)  Sleep Aid  Tried as an anaesthetic agent  Used as date rape drug  Tried as Tx for narcolepsy, ETOH withdrawal
  3. 3. Street Names (What the cool people call it!!!)  GBH (grievous bodily harm)  Liquid ecstasy  Fantasy  Cherry Meth  G  Georgia home boy  Goop  Salty water  Scoob  SCGH Alcohol & Drug Liaison Project
  4. 4. Is it in WA  We tend to be the virgin state.  Popular on the east coast during rave’s  Popular in the media  Move raves/festivals each year in Perth
  5. 5. What is it?  Colourless  Odourless  Bitter tasting liquid  Can also be powder
  6. 6. Pharmacology  Gamma hydroxybutytric acid  Crosses blood-brain barrier  CNS depressant that's abused for its ability to induce euphoria, hypnosis, and amnesia.  Toxicity occurs from depressant effects (cns/resp)
  7. 7. Pathophysiology The GHB Clinical Syndrome generally presents with: 1. CNS depression 2. Nystagmus 3. Respiratory depression 4. Miosis 5. Myoclonus 6. Vomiting  Patient typically present’s with coma, resp depression, mild bradycardia, and vomiting.
  8. 8. Differential Dx:  Look @ what else can cause:  COMA, SEIZURES, RESP depression/arrest  Hypoglycaemia  Opiate OD, Ketamine OD  SAH  CVA  CNS Lesion  Infection
  9. 9. Clinical Features Cardio: Resp:  Bradycardia Depression  Hypotension Apnoea  Hypertension Aspiration  ECG Changes Cheyne-stokes Gastro:  Nausea  Vomiting  Caustic Burns
  10. 10. Clinical Features Neuro: Metabolic:  CNS depression Resp Acidosis  Coma Metabolic Acidosis  Myoclonus Hypernatreamia  Seizures Hypokalaemia  Miosis Hyperglycaemia  Ataxia  Agitation  Euphoria  Amnesia  Dizziness  EPS
  11. 11. Investigations Tox Screen:  12 lead ECG  BSL  Paracetamol level  Temp
  12. 12. Acute Management  Management is supportive of ABC  Airway  Breathing  Circulation 1. Tx: bradycardia with atropine 2. Hypotension responds fluid challenge  Disability 1. Can be combative, need restraints, ?sedation 2. Decreasing GCS = Intubate 3. ?? Use of Physostigmine  Exposure 1. Other drugs on board (commonly ETOH, Amphetamines) 2. Other toxidromes
  13. 13. Decontamination  AC not clinically useful as onset CNS depression occurs rapidly Enhanced Elimination:  Not clinically uselful  (Toxicology handbook, 2007, p201)
  14. 14. Antidotes  Physostigmine has been used and proposed as antidote for GHB  Poor safety profile in GHB
  15. 15. Withdrawal  GHB very addictive  Need frequent ingestions to WD
  16. 16. Withdrawal Mx  Supportive Care  Benzo’s (Diazepam)  Phenothiazines (Olanzapine)
  17. 17. Prehospital Presentations  Victorian study looked @ ambulance related attendances for GHB Vs Heroin  Retrospective analysis from Mar 01- Oct 05.  Dietze, P.(2008). Patterns and incidences of y- hydroxybutyrate (GHB)-related ambulance attendances in Melbourne, Victoria. MJA, 188(12), 709-711
  18. 18. Presentations to ED
  19. 19. The Gold Coast Experience  Harraway, T., & Stephenson, L.(1999). Gamma hydroxbutyrate intoxication: The Gold Coast experience. Emergency Medicine, 11, 45-48
  20. 20. Kiddies stuff
  21. 21. Fatalities  Australasia study Jan 2000 – Aug 2003.  10 confirmed GHB Deaths  Caldicott, D, Et al.(2004).Fatalities associated with the use of y- hydroxybutyrate and its analogues in Australasia. MJA, 18(6), 310-313.
  22. 22. Drink spiking!!  Has been reported as date rape drug!
  23. 23. Disaster Preparedness  Multiple pts presenting in short period of time  Often present 0400-0800 (decreased staffing)  Need for multiple ventilators  Need to call in staff  Arrange ICU beds
  24. 24. References  Caldicott, D, Et al.(2004).Fatalities associated with the use of y-hydroxybutyrate and its analogues in Australasia. MJA, 18(6), 310-313  Dietze, P.(2008). Patterns and incidences of y- hydroxybutyrate (GHB)-related ambulance attendances in Melbourne, Victoria. MJA, 188(12), 709- 711  Harraway, T., & Stephenson, L.(1999). Gamma hydroxybutyrate intoxication: The Gold Coast experience. Emergency Medicine, 11, 45-48
  25. 25. The End

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