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Substance Abuse

Substance abuse:

Alcohol abuse = medical, behavioral or social problems related to excessive alcohol consumption
Alcoholism = chronic dependence on alcohol and a pattern of abnormal behaviors.

Severe intoxication can result in cardiac dysrhythmias, shock and death. Conditions that may mimic alcohol intoxication: drug abuse, brain tumor, hypoglycemia, meningitis, head injury, stroke, postictal state, DKA, hypoxia

Emergency care: ABCs, hi-flow O2, check blood sugar, transport severely intoxicated patients

Withdrawal Syndromes: Shakes (within 24 hours), seizures (24-48 hours after stopping drinking), delirium tremens (DTs – within 12-48 hours delirium, hallucinations, fever, tachycardia, hypertension. 15% die.)

Drugs: taken by mouth, injected, or placed on skin to treat or prevent a disease or condition.
Ethical: manufactured by legitimate pharmaceutical company to treat specific diseases or conditions
Illicit: manufactured illegally for the purpose of abuse
Drug misuse: intentional or accidental use of a drug not as intended
Drug abuse: use of a drug for a non-therapeutic effect – to get high etc.
Drug addiction: overwhelming desire to continue taking a drug to get a desired effect. True addiction is both psychological and physical. Drug dependence is just psychological.
Drug withdrawal: signs and symptoms resulting from abrupt cessation of use

Five classes of abused drugs:
Stimulants – uppers. Cocaine, meth, speed, caffeine hyperactivity, euphoria, tachycardia, sleeplessness, seizures
Depressants – downers. Marijuana, barbiturates, sleeping pills, antidepressants, tranquilizers. Sluggishness, slurred speech, decreased respiration and resp. arrest.
Hallucinogens – LSD, mescaline, psilocybin and PCP. Unpredictable behavior, hallucinations, tachypnea, nausea, dilated pupils, tachycardia, hypertension
Narcotics – heroin, morphine, methadone… drowsiness, impaired coordination, sweating, resp. depression, constricted pupils, shock, convulsions and coma
Volatile Chemicals – aerosols, glue, gasoline, freon. Altered LOC, swollen mucus membranes of mouth and nose, hypertension, tachycardia, resp. distress, nausea

Assessment: Expect the history to be unreliable, ask “were you trying to hurt yourself?” Expect a mixture of drugs and alcohol, violent behavior is common

Management:
Maintain the airway, assist as necessary
Monitor patient for deterioration in respirations
O2 by nasal cannula or non-rebreather
Watch for vomiting of course
Prepare to suction
Notify Law Enforcement/Poison Control
Measure blood sugar
Monitor ECG
Place an IV
Monitor for shock
Restrain patient as necessary
Do not be judgmental

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