Punk’s & DrunksBy: Kane Guthrie

RN SCGH ED

Is there a problem in WA?Biggest issues in EDAlcoholOverdosesMental Health IssuesHeroinDrug Induced PsychosisRecreational Drug use occasionally

OverdosesMost CommonParacetamolBenzodiazepinesAntidepressantAntipsychoticsAntiepilepticOpioidsAlcohol 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.b. 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 ConditionsSome medical conditions can make casualties

present to us as they are intoxicated, be vigilant for:

Head InjuryDiabetesEpilepsyInfectionPrescribed drug toxicity.

Why do people take recreational drugs!EuphoriaPeer PressureSocial accepted?To fit inExperimentationLack of understandingRegular use can lead to addiction!!

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

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 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).

Drugs TypesThe Groups:StimulantsDepressantsHallucinogens

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

Stimulants

SpeedEcstasy (Most Common)CocaineAmphetamines (Meth, Crystal)

Amphetamines

Positive signs of Amphetamines

Positive signs of Amphetamines

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

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.

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.

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

Stimulant Signs and SymptomsIncreased BPIncreased HRIncreased TempIncreased RRPupils dilatedAlert, aroused, agitated, paranoid, AggressiveHeadaches, Can Develop:MI, CVA ,Seizures, Psychosis

Stimulants ManagementDRABCMonitor Vital SignsLow stimuli environmentMay require security/policeMay need t/f to hospital

DepressantsAlcoholHeroin (Opiates)GHB Toxicity

Depressant Signs & SymptomsDecreased Conscious stateDecrease RRMay have Low BP & HRSmall Pupils

Depressant ManagementDRABCConscious state can deteriorate quicklyMay require respiratory supportArrange transport to hospital? Naloxone use in prehospital environment

HallucinogensLSD (lysergic acid diethylamide)Magic MushroomsAnticholinergics (datura, angles trumpet)Ketamine (dissociative) Marijuana

Hallucinogen Signs & SymptomsBizarre thought disordered behaviourVisual or auditory hallucinationsAnxietyIncreased HRImpaired coordinationParanoid

Hallucinogens ManagementDRABCLow stimuli environmentMay require restraint and sedationConscious state can deteriorate quickly Can develop fast heart rates

Some end up in ICU

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

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.

Violence and AggressionManagement:May require Restraint by police,Rapid sedation Low stimuli environmentPatients generally remember everything that

happens

WA Poisons Information Centre13 11 26Located next SCGH EDExcellent resource for finding out informationAvailable 24/7

The End