20 - Patients Under the Influence

patients under the influence 20-1

ChapterChapter

XXXX PATIENTS PATIENTS UNDER THE UNDER THE

INFLUENCE OF INFLUENCE OF ALCOHOL OR ALCOHOL OR

DRUGSDRUGS


OverviewOverview Common intoxicants Signs and symptoms of commonly

abused drugs Strategies for dealing with the

intoxicated patient


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.


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


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


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


Signs & SymptomsSigns & Symptoms SEDATIVES

Librium, Valium, Xanax, Ativan, Thorazine, barbiturates

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


Assessment of the Assessment of the Intoxicated PatientIntoxicated Patient

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


Key PointKey Point

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


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.


Scene Size-upScene Size-up Be aware of surroundings:

» Dangers to you and patient?» Medication bottles?» Drug or alcohol containers?» Drug paraphernalia?


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.


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.


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.


Reeves SleeveReeves Sleeve For safe restraint of the combative patient


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.


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.


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.


Questions?Questions?

20 - Patients Under the Influence

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