International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Patients...

International Trauma Life Supportfor Emergency Care Providers

CHAPTER

seventh edition

Patients Under the Influence of Alcohol or Drugs

20

International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians

Patients Under the Influence

Courtesy of Louis B. Mallory, MBA, REMT-P


Overview

• Signs and symptoms of under influence of alcohol and/or drugs

• Five strategies to ensure cooperation • Situations to restrain patients and

how to handle an uncooperative patient• Special considerations for assessment

and management with substance abuse


Under Influence

• Trauma and alcohol or drugs– Car crashes involving alcohol– Substance abusers at greater risk of injury– High rate of alcohol and drug use in fatalities

• Suspicion of alcohol or drug influence– Use high index of suspicion, physical exam,

history, bystanders, evidence at scene to identify


Patients Under Influence

• Unique challenges for management– Under the influence vs. an emergency– May need to alter management techniques– Many initially refuse treatment– Interaction and cooperation

• Consult local protocol, medical direction, and law enforcement for assistance


Assessment

• ITLS Primary and Secondary Surveys• Note:

– Mental status– Respiration– Speech– Pupils– Needle marks

© Pearson


Mental Status

• Altered mental status – Euphoria – Psychosis– Paranoia – Confusion – Disorientation– Due to head injury, shock, hypoglycemia until

proven otherwise



Under Influence

• Respirations– Significantly depressed

Opiates and sedatives

• Speech– Slurred

Alcohol or sedatives

– Ramble– Hallucinogens



Pupils

• Constricted– Opiates– Early barbiturate use

• Dilated– Amphetamines– Cocaine– Hallucinogens– Marijuana

• Fixed and dilated– High-dose barbiturates



Commonly Abused Drugs


Interaction

• Interaction style influences cooperation– Offensive and judgmental

Can cause patients to be uncooperative Can lengthen on-scene time

– Positive and nonjudgmental Can cause patients to be cooperative Easier assessment with all appropriate

interventions


Interaction Strategies

• Improving cooperation– Identify yourself and orient patient to

surroundings– Treat with respect and avoid being judgmental– Acknowledge concerns and feelings– Let patients know what will be required of

them– Ask closed-ended questions for history


Uncooperative Patient

• Interacting with uncooperative patients:– Be firm– Set limits to behavior– Consider physical restraint

Only if unable to provide adequate care Show of force may be enough


Restraints

• Know local protocols– Law enforcement– Threat to self– Types of restraints

Spinal immobilization Reeves sleeve Soft restraints Chemical © Pearson


Patients Under Influence

• ITLS Primary and Secondary Surveys• Note:

– High risk for infection– Look for clues to substance abuse– Finger-stick glucose for altered mental status– Cardiac monitoring for altered mental status– High-flow oxygen and capnography– Hypothermia and hypotension common


Specific Treatments


NIDA 2009 USA Study

• Teenage drug use decreasing• Belief MDMA (ecstasy) not harmful• Concerned with nonmedical use of:

– Hydrocodone (Vicodin)– Oxycodone (OxyContin)


Summary

• Know signs and symptoms of abuse:– Recognize patient who may be impaired – Attention to specific areas for critical changes – Provide lifesaving interventions for

substances

• Interaction strategies for improving patient cooperation are very important

• Safety is primary concern

International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Patients...

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