PATIENTS UNDER THE INFLUENCE OF ALCOHOL OR DRUGS

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PATIENTS UNDER THE INFLUENCE OF ALCOHOL OR DRUGS
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Overview

• Common intoxicants
• Signs and symptoms of commonly abused drugs
• Strategies for dealing with the intoxicated
  patient

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Trauma 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 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 Symptoms

• Same as amphetamines plus chest pain and lethal
  arrhythmias
• Hallucinations, dizziness, dilated pupils,
  nausea, rambling speech, psychosis, combative,
  often unaware of pain

• COCAINE
• Coke, crack, blow, rock
• HALLUCINOGENS Acid, LSD, PCP

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Signs 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 Symptoms

• SEDATIVES Librium, Valium, Xanax, Ativan,
  Thorazine, barbiturates

• Altered LOC, dilated pupils, bradycardia,
  respiratory depression, hypothermia

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Assessment of the Intoxicated Patient

• Pay careful attention to
• Mental status
• Speech
• Pupils
• Vital signs
• Presence of needle marks

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Key Point

• The injured patient with an altered LOC has a
  head injury until proven otherwise.

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History

• 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-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 the Intoxicated Patient

• Identify yourself.
• Be respectful and nonjudgmental.
• Acknowledge patients concerns and feelings.
• Be honest.
• Explain what you are doing.
• Ask closed-ended questions.

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The Uncooperative Injured 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 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 Sleeve

• For safe restraint of the combative patient

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Field 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 Management

• OPIATES
• SEDATIVES

• Watch for respiratory depression, hypothermia,
  and hypotension. ALSNarcan (naloxone) IV.
• Watch for respiratory depression, hypothermia,
  and hypotension. ALSmay try Narcan (naloxone)
  IV.

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Summary

• 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?