Drugs & Alcohol In the Emergency Department Dr Sam Perry Emergency Medicine Consultant Western Infirmary Glasgow.

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Presentation transcript:

Drugs & Alcohol In the Emergency Department Dr Sam Perry Emergency Medicine Consultant Western Infirmary Glasgow

History of Emergency Medicine Referred to as Casualty/A&E/Em Med Casualty derived from ‘casual’ Workhouse term for: ‘irregular & 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 harm 2,730 (4%)

Illicit drug use 193 (0.2%) Alcohol 1,372 (2%) Opiate overdoses 73

All Attendances by age

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 Poisoning Hypertension Seizures Confusion Nausea/abdo pain Eclampsia Hypertension Seizures/coma Confusion Proteinuria Epigastric pain

Drug related deaths & attendance in the ED

Number of contacts Range

Mode 1 for all years

Attendances prior to death

2006 Number of those attending with OD prior to death

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