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Introduction. Intoxication is a state of being poisoned. There are many medical conditions that may mimic intoxication. Intoxicated patients are unpredictable, protect yourself first! Good supportive care (ABC’s) is the mainstay of treatment for nearly all intoxications. Intoxicants.

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Introduction

Introduction

Intoxication is a state of being poisoned.

There are many medical conditions that may mimic intoxication.

Intoxicated patients are unpredictable, protect yourself first!

Good supportive care (ABC’s) is the mainstay of treatment for nearly all intoxications.


Intoxicants

Intoxicants

  • Depressants

    • Heroin

    • GHB

    • Alcohol

  • Stimulants

    • Amphetamines

    • MDMA (Ecstasy)

    • Cocaine

  • Hallucinogens

  • Synthetics


  • Depressants

    Depressants

    Depressants don’t make you depressed.

    Depress the function of nerve cells and the brain.

    The brain cells that are often depressed first are the inhibitory cells – so the patient may initially be excited, aroused or disinhibited. Once this phase is over everything else becomes depressed.


    Heroin

    Heroin

    Opiate derived from opium.

    Potently euphoric

    Users build up a rapid tolerance

    Street preparations – unpredictable.

    Often injected – risk of blood born infection.


    Heroin what will you see and do

    Heroin – what will you see and do?

    Patients very drowsy – often unconscious.

    Look for fresh track marks & pin point pupils.

    Respiratory effort slow and shallow – often cyanosed - respiratory arrest common.

    PPE important! – ABC’s are paramount.

    Remember opiates often induce vomiting.

    Naloxone VS supportive care and transport.


    Introduction

    GHB

    What is it? – basically degreasing solvent or floor stripper mixed with drain cleaner.

    GHB naturally occurs in the body and is a metabolite (byproduct) of the brain neurotransmitter GABA.

    (gamma amino butyricacid) GABA

    (gamma hydroxybutyric acid) GHB

    (neurotransmitters are substances that establish lines of communication between brain cells).


    Introduction

    GHB

    • Clear liquid – (2 – 3ml is a normal dose)

    • In larger doses can cause rapid coma and arrest.

    • What is it called on the street?

      • Fantasy

      • GBH (grievous bodily harm)

      • G

      • Great Hormones at Bedtime

      • Easy Lay

      • Liquid E (it is not ecstasy)!!!


    Ghb what will you see and do

    GHB – what will you see and do?

    ALOC, vomiting, profound bradycardia, hypotension, hypoventilation and hypopryxia.

    Seizures, respiratory arrest and death have been reported.

    some physicians were surprised when the comatose patientsuddenly awakenedduring an intubation attempt (Cameron 2001)

    PPE! ABC’S. Airway management is paramount. Be prepared for the patient to become agitated and combative if they wake up. Rapid transport!


    Alcohol

    Alcohol

    • Alcohol is a liquid produced by fermentation. Further processing produces alcoholic drinks such as beer, wine, cider and spirits.

    • Street names - Booze, grog, piss.

    • What is a standard drink? – 10 grams of alcohol.

    • Your liver can only metabolise one drink an hour.

    • Often substances used with alcohol.


    Alcohol what will you see and do

    Alcohol – what will you see and do?

    Reduced coordination and slower reflexes - lowered inhibitions & increased confidence.

    Inappropriate sexual or violent behaviour.

    blurred vision, slurred speech, flushed appearance & unsteady gait.

    PPE! Supportive care – lateral position, patients usually maintain own airway.

    ? IV fluid therapy.


    Do not forget

    Do Not Forget

    PPE! – Personal safety.

    Good history from friends / bystanders.

    Manage ABC’s aggressively + lateral position.

    Continuous monitoring.

    Remember BSL & temp. Keep them warm.

    Consider anti-emetics and IV fluid therapy.

    Transport to hospital – these patients need monitoring.


    Stimulants

    Stimulants

    All act by either directly or indirectly increasing the amount of substances like adrenaline in the brain and nervous system.

    Keeps you awake, more alert, able to party all night.

    Hunger is suppressed by adrenaline, so appetite decreases.

    May change the user’s mood.


    Amphetamines

    Amphetamines

    Amphetamines speed up the messages going between the brain and the body.

    Amphetamines are usually produced in backyard laboratories and mixed with other substances that can have unpleasant or harmful effects.

    Street names – SPEED, whizz, go-ee, snow, zip, point, up, uppers, gogo, pure, and gas


    Amphetamines1

    Amphetamines

    • One of the most common effects of amphetamine overdose is ‘speed psychosis’, usually begins with a heightened awareness of the environment and feelings of paranoia, anxiety and tension.

    • Note on ICE – “Ice" is a common name for crystal methamphetamine. It is more potent than other forms of amphetamine.


    Amphetamines what will you see

    Amphetamines – what will you see?

    Agitated, aggressive, may behave in a paranoid manner.

    Dilated pupils, hot skin, dry mouth, palms may be sweating.

    Complaining of chest pain or racing heart.

    Complains of being unable to sit still or of being very restless.

    Often demanding something to calm them down.


    Amphetamines what will you do

    Amphetamines – what will you do?

    Try to be calm, non threatening and non judgemental – reassurance +++

    Offer a supportive and quiet environment if possible.

    In the event of chest pain, racing pulse or collapse then respond as appropriate to those conditions.

    Paranoia or psychosis may result and need attention including safe observation / sedation.


    Mdma ecstasy

    MDMA (Ecstasy)

    An amphetamine analogue.

    Acts in a similar fashion.

    Generally felt to be milder in peak effect.

    More activity on mood alteration.

    Common at Rave parties

    Most users don’t drink alcohol, opposite effect.

    Often drinking bottles water all night during activity.


    Mdma ecstasy what will you see

    MDMA (Ecstasy) – what will you see?

    Collapse at or after Dance party etc.

    Very hot skin.

    Dilated pupils.

    Rapid heart rate.

    Blood pressure may be high, or low from dehydration and shock.

    Muscles may be very tense, high tone.


    Mdma ecstasy what will you do

    MDMA (Ecstasy) – what will you do?

    Good supportive care is again the rule.

    Ensure your own safety and call for assistance.

    Airway, Breathing and Circulation.

    Severe dehydration or circulatory collapse from ecstasy intoxication will most often need emergency department or even intensive care treatment.

    Drug interactions with MDMA are a danger.


    Cocaine

    Cocaine

    Most potent and most rapidly acting of the stimulants.

    May be snorted (doing lines) smoked (as crack or as free base) or applied to mucous membranes (inside mouth, under tongue etc)

    Is a ester local anaesthetic made from the leaves of the Coca plant.

    Leaves of Coca plant used by Andean and Inca civilisations to stimulate workers.


    Cocaine1

    Cocaine

    • Cocaine is uncommon in Queensland.

    • Side effects most likely to be of concern are

      • Seizures

      • Collapse

      • Chest pain (cocaine chest pain syndrome)

      • Psychiatric problems

    • Due to cost, more likely to encounter in wealthy areas of state, eg Gold Coast.


    Cocaine what will you do

    Cocaine – what will you do?

    Good supportive care.

    Ensure your own safety and call for assistance.

    Airway, Breathing and Circulation.

    Chest pain with this intoxication is associated with heart attack and death even in young people, emergency department assessment is required.

    Consider ECG and IV access.


    Do not forget1

    Do Not Forget

    PPE & personal safety.

    Good history and assessment.

    Again supportive care is the mainstay.

    Acquire an ECG in all patients / as indicated.

    Consider IV access and fluid therapy.

    Transport to hospital as required, especially patients who have suffered a cocaine intoxication.


    Hallucinogens

    Hallucinogens

    LSD, Datura & Magic Mushrooms

    Much rarer intoxications.

    Much harder to help the patient because of the distortion of perception.

    Patient is at much greater risk of inadvertent self harm and must be closely watched.

    People who use hallucinogens tend to seek a safe place and safe company first.


    Introduction

    LSD

    LSD was discovered in 1938 and is one of the most potent mood and perception altering drugs. Synthesised from lysergic acid.

    Clear or white, odourless & Soluble.

    It is highly potent and only very small doses are required to produce a hallucinogenic effect.

    Street names - acid, trips, wedges, windowpane, blotter, microdot


    Lsd what will you see and do

    LSD – What will you see and do?

    trance-like state, excitation, euphoria, increased pulse rate, insomnia, hallucinations, paranoia

    Reassurance ++.

    Manage patients symptomatically.

    If no improvement transport to hospital.


    Datura

    Datura

    • DaturaStramonium, Jimson Weed

      • Uncommon in Australia

    • BrugmansiaArborea, Angels Trumpet

      • Quite common and most likely source of this.

    • May smoke, make tea from, eat etc flowers, leaves, seeds and so on.

    • Contain atropine and scopolamine among other things. Both are anticholinergic.


    Datura what will you see

    Datura – What will you see?

    • Anticholinergic Syndrome

      • Dry as a desert

      • Red as a beetroot

      • Hot as hell

      • Blind as a bat

      • Mad as a hatter

    • Dry mouth, eyes etc

    • Skin hot, flushed, dry

    • Body temperature up

    • Pupils very dilated

    • Elevated pulse rate

    • Not passing urine

    • Abdominal pain, swelling

    • Visual hallucinations

    • May be very frightened or agitated,

    • Delirium


    Datura what will you do

    Datura – What will you do?

    As always, DRABC

    Hyperthermia, dehydration and other effects often require very specific therapy.

    Be as calm, non threatening and supportive as possible. Helps settle the delirious patient

    Delirium will last several to many hours and may need observation and possible sedation for safety in hospital.


    Things to remember

    Things to remember

    PPE! All of the ppe!

    Personal safety is paramount.

    Reassurance +++

    Aggressive management of ABC’s important.

    Continuous monitoring.

    Transport if no improvement or as required.


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