20 - patients under the influence
TRANSCRIPT
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ChapterChapter
XXXX PATIENTS PATIENTS UNDER THE UNDER THE
INFLUENCE OF INFLUENCE OF ALCOHOL OR ALCOHOL OR
DRUGSDRUGS
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OverviewOverview Common intoxicants Signs and symptoms of commonly
abused drugs Strategies for dealing with the
intoxicated patient
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Trauma and IntoxicantsTrauma and Intoxicants Alcohol is commonly associated
with trauma. Other intoxicants also increase
trauma risk. Intoxicants make assessment and
management more difficult. Be very suspicious of occult injuries
in intoxicated patients.
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Signs & SymptomsSigns & Symptoms ALCOHOL
AMPHETAMINES Bennies, ice, speed, uppers, dexies
Altered LOC, coma, combativeness slurred speech
Excitement, agitation, dilated pupils, tachycardia, tremors, seizures, paranoia, fever, psychosis
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Signs & SymptomsSigns & Symptoms COCAINE
Coke, crack, blow, rock
HALLUCINOGENS Acid, LSD, PCP
Same as amphetamines plus chest pain and lethal arrhythmias
Hallucinations, dizziness, dilated pupils, nausea, rambling speech, psychosis, combative, often unaware of pain
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Signs & SymptomsSigns & Symptoms MARIJUANA
Grass, hash, pot, tea, weed
OPIATES Heroin, horse, Big H, Darvon, codeine, Lortab, morphine, smack
Euphoria, sleepiness, dilated pupils, dry mouth, distortion of time & space
Altered LOC, constricted pupils, hypotension, respiratory depression, hypothermia
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Signs & SymptomsSigns & Symptoms SEDATIVES
Librium, Valium, Xanax, Ativan, Thorazine, barbiturates
Altered LOC, dilated pupils, bradycardia, respiratory depression, hypothermia
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Assessment of the Assessment of the Intoxicated PatientIntoxicated Patient
Pay careful attention to:» Mental status» Speech» Pupils» Vital signs» Presence of needle marks
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Key PointKey Point
The injured patient with an altered LOC has a head injury until proven otherwise.
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HistoryHistory When the patient appears intoxicated, ask about:
» Drug use Prescription and nonprescription
» When was the drug taken?» How much was taken?» Were other drugs taken as well?
“Street drugs” may not actually be what the patient thought he was buying.
Use all sources available for history.
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Scene Size-upScene Size-up Be aware of surroundings:
» Dangers to you and patient?» Medication bottles?» Drug or alcohol containers?» Drug paraphernalia?
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Strategies to Deal with Strategies to Deal with the Intoxicated Patientthe Intoxicated Patient
Identify yourself. Be respectful and nonjudgmental. Acknowledge patient’s concerns
and feelings.» Be honest.
Explain what you are doing. Ask closed-ended questions.
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The Uncooperative The Uncooperative Injured PatientInjured Patient
Be firm. Set limits to behavior. Maintain professional stature. Use physical restraint as last resort. There may be no good solution to
management of these patients.
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Physical RestraintPhysical Restraint Be aware of local laws and
protocols. Utilize law enforcement assistance. Use care not to harm or further injure
patient during restraint. Do not become injured yourself.
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Reeves SleeveReeves Sleeve For safe restraint of the combative patient
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Field ManagementField Management ALCOHOL
AMPHETAMINES
COCAINE
IV thiamine and glucose. Watch for hypothermia, be
prepared to restrain if patient becomes combative.
Monitor for seizures and dysrhythmias.
Monitor for seizures and dysrhythmias.
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Field ManagementField Management OPIATES
SEDATIVES
Watch for respiratory depression, hypothermia, and hypotension. ALS–Narcan (naloxone) IV.
Watch for respiratory depression, hypothermia, and hypotension. ALS–may try Narcan (naloxone) IV.
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SummarySummary Maintain high index of suspicion for
injuries. Scene Size-up can be very helpful. Be nonjudgmental and respectful but firm. Follow standard BTLS guidelines. Have prepared protocol for uncooperative
patients. Use specific therapy when indicated.
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Questions?Questions?