1. 1 Ch. 15-Drug and Alcohol Emergencies

2. 2 Determining Whether an Emergency Is Drug or Alcohol Related Inspect the area immediately around the victim for evidence of drug or alcohol use—empty or partially filled pill bottles, syringes, empty liquor bottles, and so on. The victim may have drugs on his person. Check for these only if the patient’s condition allows, and you are permitted to do so. Inspect the area immediately around the victim for evidence of drug or alcohol use—empty or partially filled pill bottles, syringes, empty liquor bottles, and so on. The victim may have drugs on his person. Check for these only if the patient’s condition allows, and you are permitted to do so. Check the victim’s mouth for signs of partially dissolved pills or tablets; if you find any, remove them. Check the victim’s mouth for signs of partially dissolved pills or tablets; if you find any, remove them. Smell the victim’s breath for traces of alcohol. (Do not confuse a musky, fruity, or acetone odor for alcohol— all three can indicate diabetic coma.) Smell the victim’s breath for traces of alcohol. (Do not confuse a musky, fruity, or acetone odor for alcohol— all three can indicate diabetic coma.) Ask the victim’s friends or family members or any witnesses what they know about the incident. Ask the victim’s friends or family members or any witnesses what they know about the incident.

3. 3 The following six signs and symptoms indicate a life threatening emergency 1. Unconsciousness—the victim cannot be awakened or, if awakened, lapses back into unconsciousness almost immediately. 2. Breathing difficulties—the victim’s breathing may have stopped, may be weak and shallow, or may be weak and strong in cycles. The victim’s exhalations may be raspy, rattling, or noisy. The victim’s skin may be cyanotic, indicating lack of oxygen. 3. Fever—any temperature above 100°F (38°C) may indicate a dangerous situation when drugs and/or alcohol are involved. 4. Abnormal or irregular pulse—any pulse less than 60 or more than 100 beats per minute may indicate danger, as does a pulse that is irregular (not rhythmical). 5. Vomiting—while not fully conscious 6. Convulsions—an impending convulsion may be indicated by twitching of the face, trunk, arms, or legs; muscle rigidity; or muscle spasm.

4. 4 PROGRESS CHECK 1. Alcohol on the breath does not smell musky, fruity, or acetone; those odors are caused by ____________. (insulin shock/hypoglycemia/diabetic coma) 2. A life-threatening emergency is indicated by a pulse lower than ____________ beats per minute. (50/60/70) 3. A fever higher than ____________ °F indicates a life- threatening emergency if drugs are involved. (99/100/101)

5. 5 15.2 Alcohol Emergencies Acute Intoxication Acute Intoxication Drowsiness Drowsiness Disordered speech and gait Disordered speech and gait Violence Violence Destructive or erratic behavior Destructive or erratic behavior Binge Drinking Binge Drinking Stupor Stupor Unresponsiveness Unresponsiveness Vomiting Vomiting Withdrawal Syndrome Withdrawal Syndrome Insomnia Insomnia Muscular weakness Muscular weakness Fever Fever Seizures Seizures Disorientation, confusion, and thought-process Disorientation, confusion, and thought-process Disorders Disorders Hallucinations Hallucinations Anorexia Anorexia Nausea and vomiting Nausea and vomiting Sweating Sweating Rapid heartbeat Rapid heartbeat

6. 6

7. 7 Four general stages of alcohol withdrawal Stage 1, which occurs within about 8 hours of a cutback in alcohol, is characterized by nausea, insomnia, sweating, and tremors. Stage 2, which occurs within 8 to 72 hours, is characterized by a worsening of Stage 1 symptoms, plus vomiting and illusions or hallucinations. Stage 3, which usually occurs within 48 hours, is characterized by major seizures. Stage 4 is characterized by delirium tremens.

8. 8 Delirium Tremens Severe confusion Severe confusion Loss of memory Loss of memory Tremors Tremors Restlessness Restlessness Extremely high fever Extremely high fever Dilated pupils Dilated pupils Profuse sweating Profuse sweating Insomnia Insomnia Nausea Nausea Diarrhea Diarrhea Hallucinations, mostly of a frightening nature Hallucinations, mostly of a frightening nature

9. 9 PROGRESS CHECK 1. Alcohol is completely absorbed from the stomach and intestines within ____________ hours. (2/3/4) 2. Alcohol is concentrated in the blood and the ____________. (liver/brain/spleen) 3. Acute intoxication mimics ____________. (epilepsy/cerebral hemorrhage/insulin shock) 4. ____________ syndrome occurs when blood alcohol levels start to fall after intoxication.(Withdrawal/Habituation/Metabolic acidosis) 5. Delirium tremens are characterized by confusion and ____________, usually of a frightening nature. (seizures/hallucinations/thought process disorders) 6. ____________ is fatal in about 15 percent of the cases. (Alcoholism/Delirium tremens/Withdrawal syndrome)

10. 10 Observation and Assessment Severity of Intoxication Severity of Intoxication Level of Consciousness Level of Consciousness Obtaining a History Obtaining a History

11. 11 Signs That Immediate Medical Attention Is Needed Nervous system depression (sleepiness, coma, lethargy, and decreased response to pain) Nervous system depression (sleepiness, coma, lethargy, and decreased response to pain) Tremors (especially if the victim is suffering withdrawal) Tremors (especially if the victim is suffering withdrawal) Withdrawal accompanied by pain Withdrawal accompanied by pain Digestive problems that include vomiting, bleeding, and dehydration Digestive problems that include vomiting, bleeding, and dehydration Slow or absent breathing Slow or absent breathing Grand mal seizures Grand mal seizures Delirium tremens Delirium tremens Disturbances of vision, mental confusion, and muscular incoordination Disturbances of vision, mental confusion, and muscular incoordination Disinterested behavior and loss of memory Disinterested behavior and loss of memory

12. 12 General Guidelines for Managing a Drug/Alcohol Crisis 1. Assure your own personal safety. 2. Provide a reality base. 3. Provide appropriate nonverbal support. 4. Encourage communication. 5. Foster confidence

13. 13 Managing a Violent Drug/Alcohol Victim To prevent a victim from becoming violent, take these steps: 1. Do not invade the person’s personal space (moving closer than 3 feet to the victim). Getting too close may seem threatening. 2. Use a calming voice and compassionate tone. 3. Do not place objects between the victim and the door or appear as if you are blocking his or her escape. 4. Move dangerous objects out of sight and reach of the victim. If a victim is violent: 1. Leave the scene and notify law enforcement authorities. 2. Do not attempt restraint unless you are trained and authorized to do so and you have sufficient people to do so effectively. 3. Leave the scene at any time weapons of any type are used or threatened.

14. 14 First Aid Care for Overdose 1. Be prepared for cardiac arrest. Constantly monitor vital signs; your primary priority is to maintain an open airway. 2. Do not panic; treat the victim calmly. Move a victim who is inhaling a harmful substance or who is in immediate danger from surroundings. Do not place yourself in danger. 3. If the person is conscious, try to get the victim to sit or lie down. Do not use restraints unless the victim poses a risk to safety. 4. Establish and maintain a clear airway. Remove anything from the mouth or throat that might pose a breathing hazard, including false teeth, blood, mucus, or vomitus. Administer artificial ventilation if needed. 5. Turn the victim’s head to the side or toward the ground in case of vomiting 6. Monitor the victim’s vital signs frequently 7. Try to maintain proper body temperature 8. Take measures to correct or prevent shock, which can result from vomiting, profuse sweating, or inadequate fluid intake. 9. Reduce stimuli as much as possible; lower the lights if you can, and let the victim rest in a calm, quiet atmosphere. 10. Carefully explain each step of care so that you can help reduce paranoia.

15. 15 The Talk-Down Technique 1. Make the victim feel welcome. Remain relaxed and sympathetic. 2. Reassure the victim that his or her strange mental condition is caused by the drug and will not last forever 3. Identify yourself clearly 4. Help the victim verbalize what is happening. Review for the victim what is going on 5. Reiterate simple and concrete statements; repeat and confirm what the victim says

16. 16 Vocabulary Withdrawal syndrome- A four-stage syndrome that occurs after a cutback in the amount of alcohol a person is used to or when blood alcohol levels start to fall after severe intoxication Withdrawal syndrome- A four-stage syndrome that occurs after a cutback in the amount of alcohol a person is used to or when blood alcohol levels start to fall after severe intoxication Delirium tremens- A life-threatening condition causing delirium that usually occurs within 5 days of an alcoholic’s last drink Delirium tremens- A life-threatening condition causing delirium that usually occurs within 5 days of an alcoholic’s last drink

17. 17 15.4 Drugs of Concern Hallucinogens Hallucinogens Stimulants Stimulants Depressants/Narcotics Depressants/Narcotics Other Drugs of Abuse Other Drugs of Abuse

18. 18 PROGRESS CHECK 1. The most important information to gather during assessment of a drug/alcohol victim is severity of intoxication and ____________. (history/chief complaint/level of consciousness) 2. ____________ is a sign that medical attention is needed immediately. (Grand mal seizure/Vomiting/Rapid heartbeat) 3. One way to provide a reality base is to ____________. (maintain eye contact/listen carefully/use the victim’s name) 4. You can provide nonverbal support by _________. (touching the victim/letting the victim watch TV/listening carefully) 5. You can encourage communication by ____________. (responding to feelings/maintaining a relaxed body posture/asking questions slowly) 6. The primary goals of care are to monitor vital signs and ____________. (prevent shock/provide basic life support/prevent aspiration) 7. The top priority in caring for victims of drug/alcohol emergencies is to ____________. (maintain the airway/ maintain circulation/maintain consciousness) 8. The talk-down technique should not be used if the victim took ____________. (cocaine/PCP/alcohol)