ABD Flashcards
ABD
Sudden onset of aggressive and violent behaviour and autonomic dysfunction, typically in setting of acute or chronic drug abuse or serious MH
Causes of ABD
Adrenaline
Stimulant drugs
Mental health
Medical conditions
Linked to desensitisation of NT receptors in brain
How does ABD lead to multi organ failure
Incr sustained activity -> incr o2 use and decr co2 production -> acidosis -> multi organ failure
Effects of ABD
Sudden cardiovascular collapse
Cardiac arrest
Hyperthermia
Acidosis
Rhabdomyolysis
Disseminated Intravascular coagulation
Sedation options in abd
Benzodiazepines - midazolam
Antipsychotics - haloperidol
Ketamine
ABD signs and sx
Unexpected physical strength
Hot to touch, diaphoresis, removal of clothing
Bizarre/aggressive behaviour
Incr RR and HR
Confused thinking and speech
Agitation, disorientation, hallucination
Paranoia
Insensitivity to pain
Risk factors for restraint related deaths
Drugs especially stimulants
Alcohol (can prolong effects of drugs)
MH conditions and medications
Obesity
Pre existing heart, kidney, and resp conditions
Prolonged restraint
Drawbacks of Midazolam for sedation in ABD
Variable onset of action
Can have tolerance esp if on long term benzos
Can cause resp depression
Not CVS stable
Dose variable
Drawbacks of haloperidol for sedation in ABD
Lengthens QT - cardiovascular risk
Many interactions
20min+ onset of action
Is Droperidol or haloperidol more potent
Droperidol
Drawbacks of ketamine for sedation in ABD
Sympathomimetic - can incr HR and HTN
Need to give large volume of giving IM
Non reversible
Not resp stable
Recovery from ketamine sedation can be unpredictable - can cause visual hallucinations
