By: Kane Guthrie
RN SCGH ED
Is there a problem in WA?
 Biggest issues in ED
 Alcohol
 Overdoses
 Mental Health Issues
 Heroin
 Drug Induced Psyc...
Overdoses
 Most Common
 Paracetamol
 Benzodiazepines
 Antidepressant
 Antipsychotics
 Antiepileptic
 Opioids
 Alco...
Assessing the Intoxicated Patient!
 Obtain the following:
1. Pharmaceutical agent or toxin ingested:
 Two or more drugs ...
Assessment Continued:
6. Corroborate the history in cooperative patient, but do
not be mislead, as info supplied can be in...
Clues to look out for:
 Signs of seizure activity, assess motor function of
extremities.
 Dilated pupils: Tricyclics, am...
Medical Conditions
 Some medical conditions can make casualties present
to us as they are intoxicated, be vigilant for:
...
Why do people take recreational
drugs!
 Euphoria
 Peer Pressure
 Social accepted?
 To fit in
 Experimentation
 Lack ...
Alcohol
 Is the Bain of emergency departments
 Indicated in 30% of presentations to ED
 Pt’s difficult to assess and fi...
Alcohol Absorption
 Alcohol is rapidly absorbed from the small bowel
(around 80%), and stomach (around 20%).
 Alcohol is...
Harms of Alcohol Abuse:
 Most drinkers (73%) generally consume alcohol in ways
considered at low health risk (AIHW, 2002)...
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
 ...
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
crystall...
Types of Amphetamines
2.Crystalmethamphetamine
:
 Known as Ice, crystal
meth.
 Has a crushed ice
appearance.
 Usually s...
Cocaine
 Cocaine is a stimulant derived from the South
American coca plant
 Cocaine is either snorted, smoked, intraveno...
Ecstasy
 Ecstasy is generally the
street name applied to
MDMA.
 Used as a stimulant.
 Common at raves, night
clubs
 Kn...
Stimulant Signs and Symptoms
 Increased BP
 Increased HR
 Increased Temp
 Increased RR
 Pupils dilated
 Alert, arous...
Stimulants Management
 DRABC
 Monitor Vital Signs
 Low stimuli environment
 May require security/police
 May need t/f...
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 transp...
Hallucinogens
 LSD (lysergic acid diethylamide)
 Magic Mushrooms
 Anticholinergics (datura, angles trumpet)
 Ketamine ...
Hallucinogen Signs & Symptoms
 Bizarre thought disordered behaviour
 Visual or auditory hallucinations
 Anxiety
 Incre...
Hallucinogens Management
 DRABC
 Low stimuli environment
 May require restraint and sedation
 Conscious state can dete...
Some end up in ICU
Drink Spiking
WA study
 Prospective study of 101 patients with suspected drink
spiking
 People who thought there drink h...
Difficult Behaviours
 Can result from D&A use or Mental Illness
 Violence & Assault common occurrence in the
community e...
Violence and Aggression
 Management:
 May require Restraint by police,
 Rapid sedation
 Low stimuli environment
 Pati...
WA Poisons Information Centre
 13 11 26
 Located next SCGH ED
 Excellent resource for finding out information
 Availab...
The End
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Punks & drunks

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Presentations looking at common street drugs presenting to emergency departments.

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Punks & drunks

  1. 1. By: Kane Guthrie RN SCGH ED
  2. 2. Is there a problem in WA?  Biggest issues in ED  Alcohol  Overdoses  Mental Health Issues  Heroin  Drug Induced Psychosis  Recreational Drug use occasionally
  3. 3. Overdoses  Most Common  Paracetamol  Benzodiazepines  Antidepressant  Antipsychotics  Antiepileptic  Opioids  Alcohol most common adjunct
  4. 4. 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.
  5. 5. 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.
  6. 6. 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.
  7. 7. 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.
  8. 8. Why do people take recreational drugs!  Euphoria  Peer Pressure  Social accepted?  To fit in  Experimentation  Lack of understanding  Regular use can lead to addiction!!
  9. 9. 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
  10. 10. 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.
  11. 11. 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).
  12. 12. Drugs Types The Groups:  Stimulants  Depressants  Hallucinogens
  13. 13. 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
  14. 14. Stimulants  Speed  Ecstasy (Most Common)  Cocaine  Amphetamines (Meth, Crystal)
  15. 15. Amphetamines
  16. 16. Positive signs of Amphetamines
  17. 17. Positive signs of Amphetamines
  18. 18. 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
  19. 19. 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.
  20. 20. 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.
  21. 21. 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
  22. 22. 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
  23. 23. Stimulants Management  DRABC  Monitor Vital Signs  Low stimuli environment  May require security/police  May need t/f to hospital
  24. 24. Depressants  Alcohol  Heroin (Opiates)  GHB Toxicity
  25. 25. Depressant Signs & Symptoms  Decreased Conscious state  Decrease RR  May have Low BP & HR  Small Pupils
  26. 26. Depressant Management  DRABC  Conscious state can deteriorate quickly  May require respiratory support  Arrange transport to hospital  ? Naloxone use in prehospital environment
  27. 27. Hallucinogens  LSD (lysergic acid diethylamide)  Magic Mushrooms  Anticholinergics (datura, angles trumpet)  Ketamine (dissociative)  Marijuana
  28. 28. Hallucinogen Signs & Symptoms  Bizarre thought disordered behaviour  Visual or auditory hallucinations  Anxiety  Increased HR  Impaired coordination  Paranoid
  29. 29. Hallucinogens Management  DRABC  Low stimuli environment  May require restraint and sedation  Conscious state can deteriorate quickly  Can develop fast heart rates
  30. 30. Some end up in ICU
  31. 31. 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
  32. 32. 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.
  33. 33. Violence and Aggression  Management:  May require Restraint by police,  Rapid sedation  Low stimuli environment  Patients generally remember everything that happens
  34. 34. WA Poisons Information Centre  13 11 26  Located next SCGH ED  Excellent resource for finding out information  Available 24/7
  35. 35. The End

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