Drugs

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Drugs AlcoholIn the Emergency Department

• Dr Sam Perry
• Emergency Medicine Consultant
• Western Infirmary Glasgow

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History of Emergency Medicine

• Referred to as Casualty/AE/Em Med
• Casualty derived from casual

Workhouse term for irregular
unexpected caller who may need temporary
help
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Attendances at Emergency Department
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(No Transcript)
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Proportion of Alcohol/ Drug related attendances

• September 2008-February 2009
• GRI WIG 67,000 new attendances
• Total of alcohol/drug/deliberate self harm
• 2,730 (4)

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• Illicit drug use 193 (0.2)
• Alcohol 1,372 (2)
• Opiate overdoses 73

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All Attendances by age
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Reasons why figures are probably an underestimate

• Diagnostic recording system
• Doctors choose best guess diagnosis
• Do have an option to add more diagnoses but dont
• System is not very user friendly

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Attitudes of ED staff

• Often negative
• Patients also report attendances as a negative
  experience
• Very little undergraduate education
• Attitudes become more positive following education

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Many drug related conditions will not be included
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DVT
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Abscess
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Trauma
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Blood Born Viruses
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Cocaine use
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Case History
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• Standby call
• 17 year old girl
• 38wks pregnant
• Fitting
• Had taken 6 Es earlier that evening

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• Eclampsia
• Ecstasy poisoning
• Seizure

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• Ecstasy Poisoning
• Hypertension
• Seizures
• Confusion
• Nausea/abdo pain

• Eclampsia
• Hypertension
• Seizures/coma
• Confusion
• Proteinuria
• Epigastric pain

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Drug related deaths attendance in the ED
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Number of contacts
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Mode 1 for all years
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Attendances prior to death
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2006 Number of those attending with OD prior to
death
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Lessons

• Perception that drug users place a drain on
  emergency services not true
• Alcohol much more of a problem
• Only a minority of those who die present to ED
  prior to death
• Staff should identify drug users presenting with
  other conditions refer to appropriate
  addiction team