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Presentations looking at common street drugs presenting to emergency departments.

Presentations looking at common street drugs presenting to emergency departments.

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Punks & drunks Punks & drunks Presentation Transcript

  • Punk’s & Drunks
    By: Kane Guthrie
    RN SCGH ED
  • Is there a problem in WA?
    Biggest issues in ED
    Alcohol
    Overdoses
    Mental Health Issues
    Heroin
    Drug Induced Psychosis
    Recreational Drug use occasionally
  • Overdoses
    Most Common
    Paracetamol
    Benzodiazepines
    Antidepressant
    Antipsychotics
    Antiepileptic
    Opioids
    Alcohol most common adjunct
  • Assessing the Intoxicated Patient!
    Obtain the following:
    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:
    Rapid deterioration in conscious level.
    Seizures.
  • 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.
  • 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.
  • Medical Conditions
    Some medical conditions can make casualties present to us as they are intoxicated, be vigilant for:
    Head Injury
    Diabetes
    Epilepsy
    Infection
    Prescribed drug toxicity.
  • Why do people take recreational drugs!
    Euphoria
    Peer Pressure
    Social accepted?
    To fit in
    Experimentation
    Lack of understanding
    Regular use can lead to addiction!!
  • Alcohol
    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 mortality rate.
    Chronic use leads to organ damage
  • 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.
  • 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 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 Professionals).
  • Drugs Types
    The Groups:
    Stimulants
    Depressants
    Hallucinogens
  • How they effect the body!
    Have there effect by how they affect the CNS
    Each drug have different effects on the body
    Hard to know what is actually in street drugs
    Tolerance
    Regular use
  • Stimulants
    Speed
    Ecstasy (Most Common)
    Cocaine
    Amphetamines (Meth, Crystal)
  • Amphetamines
  • Positive signs of Amphetamines
  • Positive signs of Amphetamines
  • Types of Amphetamines
    1.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
  • Types of Amphetamines
    2.Crystalmethamphetamine:
    • 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.
  • Cocaine
    Cocaine is a stimulant derived from the South American coca plant
    Cocaine 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.
  • Ecstasy
    Ecstasy is generally the street name applied to MDMA.
    Used as a stimulant.
    Common at raves, night clubs
    Known on streets as soft drug, causes 3-5 deaths each year (WA)
    Hyperthermia, water intoxication
  • Stimulant Signs and Symptoms
    Increased BP
    Increased HR
    Increased Temp
    Increased RR
    Pupils dilated
    Alert, aroused, agitated, paranoid, Aggressive
    Headaches,
    Can Develop:
    MI, CVA ,Seizures, Psychosis
  • Stimulants Management
    DRABC
    Monitor Vital Signs
    Low stimuli environment
    May require security/police
    May need t/f to hospital
  • Depressants
    Alcohol
    Heroin (Opiates)
    GHB Toxicity
  • Depressant Signs & Symptoms
    Decreased Conscious state
    Decrease RR
    May have Low BP & HR
    Small Pupils
  • Depressant Management
    DRABC
    Conscious state can deteriorate quickly
    May require respiratory support
    Arrange transport to hospital
    ? Naloxone use in prehospital environment
  • Hallucinogens
    LSD (lysergic acid diethylamide)
    Magic Mushrooms
    Anticholinergics (datura, angles trumpet)
    Ketamine (dissociative)
    Marijuana
  • Hallucinogen Signs & Symptoms
    Bizarre thought disordered behaviour
    Visual or auditory hallucinations
    Anxiety
    Increased HR
    Impaired coordination
    Paranoid
  • Hallucinogens Management
    DRABC
    Low stimuli environment
    May require restraint and sedation
    Conscious state can deteriorate quickly
    Can develop fast heart rates
  • Some end up in ICU
  • Drink Spiking WA study
    Prospective study of 101 patients with suspected drink spiking
    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 test
  • Difficult Behaviours
    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
    Management:
    May require Restraint by police,
    Rapid sedation
    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
    Available 24/7
  • The End