Is there a problem in WA?
Biggest issues in ED
Mental Health Issues
Drug Induced Psychosis
Recreational Drug use occasionally
Alcohol most common adjunct
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.
6. Corroborate the history in cooperative patient, but do
not be mislead, as info supplied can be incomplete or
7. Rapidly assess airway patency, respiratory function,
and conscious level.
8. Record pulse, BP, RR, Temp, and BSL, pupils, & attach
9. Hypoglycaemia and hyperthermia are common
findings in collapsed patient with OD, & are
Clues to look out for:
Signs of seizure activity, assess motor function of
Dilated pupils: Tricyclics, amphetamines,
antihistamines, anticholinergics agents.
Pinpoint pupils: opiates, organophosphates.
Nystagmus: alcohol, benzodiazepines, phenytoin.
Nasal bleeding: solvent abuse.
Some medical conditions can make casualties present
to us as they are intoxicated, be vigilant for:
Prescribed drug toxicity.
Why do people take recreational
To fit in
Lack of understanding
Regular use can lead to addiction!!
Is the Bain of emergency departments
Indicated in 30% of presentations to ED
Pt’s difficult to assess and find underlying injuries
when intoxicated (esp. Head Injury)
Injured pts who are intoxicated have an increased
Chronic use leads to organ damage
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:
Presence of food in stomach
Individual factors: age, gender, size, drinking rate,
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.
30% of Car accidents
34% 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
Types of Amphetamines
Commonly know as
“speed or whiz”.
Speed varies in:
Texture ( fine
crystallised or coarse
Colour ( white to
yellow, brown, orange
Types of Amphetamines
Known as Ice, crystal
Has a crushed ice
Usually smoked, but can
be dissolved in water for
injection, can be
swallowed or snorted.
Cocaine is a stimulant derived from the South
American coca plant
Cocaine is either snorted, smoked, intravenously
Cocaine use produces euphoria, mental stimulation,
and generalised central nervous system stimulation.
Ingestion of 1g or more is potentially lethal.
Ecstasy is generally the
street name applied to
Used as a stimulant.
Common at raves, night
Known on streets as soft
drug, causes 3-5 deaths
each year (WA)
Prospective study of 101 patients with suspected drink
People who thought there drink had been spiked
encouraged to attend ED (SCGH,JHC)
97 alleged cases (88% female)
28% had illicit drugs on board
Medium Blood Alcohol was .096
Result no detectable sedative found in urine or blood
Can result from D&A use or Mental Illness
Violence & Assault common occurrence in the
community every day
Remain Open and positive
Don’t stereotype or Judge
Maintain your own safety
Everyone has a story let them tell it.
Violence and Aggression
May require Restraint by police,
Low stimuli environment
Patients generally remember everything that happens
WA Poisons Information Centre
13 11 26
Located next SCGH ED
Excellent resource for finding out information