patients under the influence 20-1

Chapter
XX
PATIENTS
UNDER THE
INFLUENCE OF
ALCOHOL OR
DRUGS
patients under the influence 20-2
Overview
Common intoxicants
Signs and symptoms of commonly
abused drugs
Strategies for dealing with the
intoxicated patient
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Trauma 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.
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Signs & Symptoms
ALCOHOL


AMPHETAMINES
Bennies, ice, speed,
uppers, dexies
Altered LOC, coma,
combativeness slurred
speech

Excitement, agitation,
dilated pupils,
tachycardia, tremors,
seizures, paranoia,
fever, psychosis
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Signs & 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


patients under the influence 20-6
Signs & 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
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Signs & Symptoms
SEDATIVES
Librium, Valium,
Xanax, Ativan,
Thorazine,
barbiturates
Altered LOC,
dilated pupils,
bradycardia,
respiratory
depression,
hypothermia
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Assessment of the
Intoxicated Patient
Pay careful attention to:
Mental status
Speech
Pupils
Vital signs
Presence of needle marks
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Key Point

The injured patient with an altered
LOC has a head injury until
proven otherwise.
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History
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.
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Scene Size-up
Be aware of surroundings:
Dangers to you and patient?
Medication bottles?
Drug or alcohol containers?
Drug paraphernalia?
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Strategies to Deal with
the Intoxicated Patient
Identify yourself.
Be respectful and nonjudgmental.
Acknowledge patients concerns
and feelings.
Be honest.
Explain what you are doing.
Ask closed-ended questions.
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The Uncooperative
Injured 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.
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Physical 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.
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Reeves Sleeve
For safe restraint of the combative patient
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Field 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.
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Field Management
OPIATES



SEDATIVES
Watch for respiratory
depression, hypothermia, and
hypotension. ALSNarcan
(naloxone) IV.

Watch for respiratory
depression, hypothermia, and
hypotension. ALSmay try
Narcan (naloxone) IV.


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Summary
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.
patients under the influence 20-19

Questions?