Patients Under the Influence of Alcohol or Drugs

Patients Under the Influence of Alcohol or Drugs 20

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

Under Influence • Respirations • Significantly depressed • Opiates and sedatives • Speech • Slurred • Alcohol or sedatives • Ramble • Hallucinogens Courtesy of Louis B. Mallory, MBA, REMT-P

Pupils • Constricted • Opiates • Early barbiturate use • Dilated • Amphetamines • Cocaine • Hallucinogens • Marijuana • Fixed and dilated • High-dose barbiturates Courtesy of Louis B. Mallory, MBA, REMT-P

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

Patients Under the Influence of Alcohol or Drugs