Transcript Drugs & Alcohol In the Emergency Department

Drugs & Alcohol
In the Emergency Department
Dr Sam Perry
Emergency Medicine Consultant
Western Infirmary Glasgow
History of Emergency Medicine
• Referred to as Casualty/A&E/Em Med
• Casualty derived from ‘casual’
Workhouse term for:
irregular & unexpected caller who
may need temporary help’
Attendances at Emergency
Department
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%)
• Illicit drug use 193 (0.2%)
• Alcohol 1,372 (2%)
• Opiate overdoses 73
All Attendances by age
70
60
50
40
all attendances
sample population
30
20
10
0
0-14yrs
15-44yrs
45-64yrs
65+yrs
Reasons why figures are probably
an underestimate
• Diagnostic recording system
• Doctors choose ‘best guess’ diagnosis
• Do have an option to add more diagnoses
but don’t
• System is not very user friendly
Attitudes of ED staff
• Often negative
• Patients also report attendances as a
negative experience
• Very little undergraduate education
• Attitudes become more positive following
education
Many drug related conditions will
not be included
DVT
Abscess
Trauma
Blood Born Viruses
Cocaine use
Case History
•
•
•
•
•
Standby call
17 year old girl
38wks pregnant
‘Fitting’
Had taken 6 E’s earlier that evening
• Eclampsia
• Ecstasy poisoning
• Seizure
Ecstasy Poisoning
Eclampsia
Hypertension
Seizures
Confusion
Hypertension
Seizures/coma
Confusion
Proteinuria
Epigastric pain
Nausea/abdo pain
Drug related deaths & attendance
in the ED
70
60
50
40
% DRD attending ED
30
20
10
0
2003
2004
2006
Number of contacts
Range
2003
2004
2006
1-35
1-17
1-14
Mode 1 for all years
Attendances prior to death
45
40
35
30
25
2003
2004
20
15
10
5
0
3months
3-6months
6-9months
9-12months
2006 Number of those attending
with OD prior to death
16
14
12
10
8
number(n=15)
6
4
2
0
1week
3months
12months
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