drugs & alcohol in the emergency department dr sam perry emergency medicine consultant western...
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Drugs & AlcoholIn the Emergency Department
Dr Sam PerryEmergency Medicine Consultant
Western Infirmary Glasgow
History of Emergency Medicine
• Referred to as Casualty/A&E/Em Med
• Casualty derived from ‘casual’
Workhouse term for:Workhouse term for:‘‘ irregular & unexpected caller whoirregular & unexpected caller who
may need temporary help’may need temporary help’
Attendances at Emergency Department
Proportion of Alcohol/ Drug related attendances
• September 2008-February 2009
• GRI& WIG 67,000 new attendances
• Total of alcohol/drug/deliberate self harm2,730 (4%)
• Illicit drug use 193 (0.2%)
• Alcohol 1,372 (2%)
• Opiate overdoses 73
All Attendances by age
0
10
20
30
40
50
60
70
0-14yrs 15-44yrs 45-64yrs 65+yrs
all attendances
sample population
Reasons why figures are probably an underestimate
• Diagnostic recording system
• Doctors choose ‘best guess’ diagnosis
• Do have an option to add more diagnoses but don’t
• System is not very user friendly
Attitudes of ED staff
• Often negative
• Patients also report attendances as a negative experience
• Very little undergraduate education
• Attitudes become more positive following education
Many drug related conditions will not be included
DVT
Abscess
Trauma
Blood Born Viruses
Cocaine use
Case History
• Standby call
• 17 year old girl
• 38wks pregnant
• ‘Fitting’
• Had taken 6 E’s earlier that evening
• Eclampsia
• Ecstasy poisoning
• Seizure
Ecstasy PoisoningHypertension
Seizures
Confusion
Nausea/abdo pain
EclampsiaHypertension
Seizures/coma
Confusion
Proteinuria
Epigastric pain
Drug related deaths & attendance in the ED
0
10
20
30
40
50
60
70
2003 2004 2006
% DRD attending ED
Number of contacts
2003 2004 2006
Range 1-35 1-17 1-14
Mode 1 for all years
Attendances prior to death
0
5
10
15
20
25
30
35
40
45
3months 3-6months 6-9months 9-12months
2003
2004
2006 Number of those attending with OD prior to death
0
2
4
6
8
10
12
14
16
1week 3months 12months
number(n=15)
Lessons
• Perception that drug users place a drain on emergency services not true
• Alcohol much more of a problem
• Only a minority of those who die present to ED prior to death
• Staff should identify drug users presenting with other conditions & refer to appropriate addiction team