Presentations looking at common street drugs presenting to emergency departments.

1. By: Kane Guthrie
RN SCGH ED

2. Is there a problem in WA?
 Biggest issues in ED
 Alcohol
 Overdoses
 Mental Health Issues
 Heroin
 Drug Induced Psychosis
 Recreational Drug use occasionally

3. Overdoses
 Most Common
 Paracetamol
 Benzodiazepines
 Antidepressant
 Antipsychotics
 Antiepileptic
 Opioids
 Alcohol most common adjunct

4. Assessing the Intoxicated Patient!
 Obtain the following:
1. Pharmaceutical agent or toxin ingested:
 Two or more drugs are taken in 30% of cases.
 Alcohol is a common adjunct.
2. Quantity of agent ingested.
3. Time since ingestion.
4. Hx of toxic effects already experience by poison.
5. Specifics of events prior to arrival:
a. Rapid deterioration in conscious level.
b. Seizures.

5. Assessment Continued:
6. Corroborate the history in cooperative patient, but do
not be mislead, as info supplied can be incomplete or
deliberately false.
7. Rapidly assess airway patency, respiratory function,
and conscious level.
8. Record pulse, BP, RR, Temp, and BSL, pupils, & attach
cardiac monitor.
9. Hypoglycaemia and hyperthermia are common
findings in collapsed patient with OD, & are
commonly overlooked.

6. Clues to look out for:
 Signs of seizure activity, assess motor function of
extremities.
 Dilated pupils: Tricyclics, amphetamines,
antihistamines, anticholinergics agents.
 Pinpoint pupils: opiates, organophosphates.
 Nystagmus: alcohol, benzodiazepines, phenytoin.
 Hyperventilation: salcylates.
 Nasal bleeding: solvent abuse.

7. Medical Conditions
 Some medical conditions can make casualties present
to us as they are intoxicated, be vigilant for:
 Head Injury
 Diabetes
 Epilepsy
 Infection
 Prescribed drug toxicity.

8. Why do people take recreational
drugs!
 Euphoria
 Peer Pressure
 Social accepted?
 To fit in
 Experimentation
 Lack of understanding
 Regular use can lead to addiction!!

9. Alcohol
 Is the Bain of emergency departments
 Indicated in 30% of presentations to ED
 Pt’s difficult to assess and find underlying injuries
when intoxicated (esp. Head Injury)
 Injured pts who are intoxicated have an increased
mortality rate.
 Chronic use leads to organ damage

10. Alcohol Absorption
 Alcohol is rapidly absorbed from the small bowel
(around 80%), and stomach (around 20%).
 Alcohol is water soluble, and little or no alcohol
enters fatty tissue.
 Reaches brain within 5mins, blood concentration
peak between 30 to 90 (Typically 45mins).
 Absorption will vary with:
 Beverage type
 Presence of food in stomach
 Individual factors: age, gender, size, drinking rate,
experience.

11. Harms of Alcohol Abuse:
 Most drinkers (73%) generally consume alcohol in ways
considered at low health risk (AIHW, 2002).
 Contributes to over 3000 deaths per year.
 18% of injuries presenting to ED.
 50% assaults.
 30% of Car accidents
 34% of drownings and falls.
 44% of fire related injuries.
Source: (CDHAC, 2001; CDHA, 2002;nhmrc, 2001;APF, 2001;
Alcohol and other drugs: A Hand book for Health
Professionals).

12. Drugs Types
The Groups:
 Stimulants
 Depressants
 Hallucinogens

13. How they effect the body!
 Have there effect by how they affect the CNS
 Each drug have different effects on the body
 Hard to know what is actually in street drugs
 Tolerance
 Regular use

14. Stimulants
 Speed
 Ecstasy (Most Common)
 Cocaine
 Amphetamines (Meth, Crystal)

15. Amphetamines

16. Positive signs of Amphetamines

17. Positive signs of Amphetamines

18. Types of Amphetamines
1.Methamphetamines:
 Commonly know as
“speed or whiz”.
 Speed varies in:
 Texture ( fine
crystallised or coarse
powder).
 Colour ( white to
yellow, brown, orange
or pink,
 Purity

19. Types of Amphetamines
2.Crystalmethamphetamine
:
 Known as Ice, crystal
meth.
 Has a crushed ice
appearance.
 Usually smoked, but can
be dissolved in water for
injection, can be
swallowed or snorted.

20. Cocaine
 Cocaine is a stimulant derived from the South
American coca plant
 Cocaine is either snorted, smoked, intravenously
administered.
 Cocaine use produces euphoria, mental stimulation,
and generalised central nervous system stimulation.
 Ingestion of 1g or more is potentially lethal.

21. Ecstasy
 Ecstasy is generally the
street name applied to
MDMA.
 Used as a stimulant.
 Common at raves, night
clubs
 Known on streets as soft
drug, causes 3-5 deaths
each year (WA)
 Hyperthermia, water
intoxication

22. Stimulant Signs and Symptoms
 Increased BP
 Increased HR
 Increased Temp
 Increased RR
 Pupils dilated
 Alert, aroused, agitated, paranoid, Aggressive
 Headaches,
Can Develop:
MI, CVA ,Seizures, Psychosis

23. Stimulants Management
 DRABC
 Monitor Vital Signs
 Low stimuli environment
 May require security/police
 May need t/f to hospital

24. Depressants
 Alcohol
 Heroin (Opiates)
 GHB Toxicity

25. Depressant Signs & Symptoms
 Decreased Conscious state
 Decrease RR
 May have Low BP & HR
 Small Pupils

26. Depressant Management
 DRABC
 Conscious state can deteriorate quickly
 May require respiratory support
 Arrange transport to hospital
 ? Naloxone use in prehospital environment

27. Hallucinogens
 LSD (lysergic acid diethylamide)
 Magic Mushrooms
 Anticholinergics (datura, angles trumpet)
 Ketamine (dissociative)
 Marijuana

28. Hallucinogen Signs & Symptoms
 Bizarre thought disordered behaviour
 Visual or auditory hallucinations
 Anxiety
 Increased HR
 Impaired coordination
 Paranoid

29. Hallucinogens Management
 DRABC
 Low stimuli environment
 May require restraint and sedation
 Conscious state can deteriorate quickly
 Can develop fast heart rates

30. Some end up in ICU

31. Drink Spiking
WA study
 Prospective study of 101 patients with suspected drink
spiking
 People who thought there drink had been spiked
encouraged to attend ED (SCGH,JHC)
 97 alleged cases (88% female)
 28% had illicit drugs on board
 Medium Blood Alcohol was .096
 Result no detectable sedative found in urine or blood
test

32. Difficult Behaviours
 Can result from D&A use or Mental Illness
 Violence & Assault common occurrence in the
community every day
 Remain Open and positive
 Don’t stereotype or Judge
 Maintain your own safety
 Everyone has a story let them tell it.

33. Violence and Aggression
 Management:
 May require Restraint by police,
 Rapid sedation
 Low stimuli environment
 Patients generally remember everything that happens

34. WA Poisons Information Centre
 13 11 26
 Located next SCGH ED
 Excellent resource for finding out information
 Available 24/7

35. The End