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Emergency Medicine xx > Alcohol and substance misuse > Flashcards

Alcohol and substance misuse Flashcards

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1
Q

signs of glue and solvent intoxification

A

Perioral rash

Eurphoria, agiration, drowsiness, slurred speech, unsteady gait

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2
Q

benzodiazepine and CNS depressant intoxification

A

Nystagmus, diplopia, strabismus, hypotonia, clumsiness, dilated pupils

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3
Q

amphetamine, ecstacy, cocaine, mephredrone intoxification features

A

Hyperstimulation, restlessness, pyrexia, sympathomimetic effects

Paranoia, violent behaviour, seizures

Cocaine: chest pain, arrhythmias, MI

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4
Q

skin complications of substance misuse

A

Cellulitis, abscesses, extensive skin necrosis, necrotizing fasciitis, tetanus, boutilism, anthrax

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5
Q

vascular complications of substance misuse

A

Phlebitis, DVT, bacterial endocarditis

Femoral artery: false aneurysms, fistulae, peripheral emboli

Limb pain, skin pallor, mottling, paraesthesiae in the presence of palpable peripheral pulses

Diffuse soft tissue damage: compartment syndromes, rhabdomyolysis, renal failure, irreversible limb damage necessitating amputation

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6
Q

orthopaedic complications of substance misuse

A

Injecting drug users: acutely painful joints, septic arthritis

Analgesia, blood cultures

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7
Q

diseases associated with alcohol misuse

A

Increased rate of heart disease

Malignancy

Stroke

Injuries

Road traffic fatalities

Drownings

Burn deaths

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8
Q

short term risk of alcohol misuse

A

Accidents and injuries: head injury

Violent behaviour and being a victim of violence

Unprotected sex: STIs

Loss of personal possessions

Alcohol poisoning; vomiting, fits, falling unconscious

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9
Q

long term risk of alcohol misuse

A

Heart disease

Stroke

Liver disease

Liver cancer

Bowel cancer

Mouth cancer

Breast cancer

Pancreatitis

Unemployment, divorce, domestic abuse, homelessness

Alcoholism

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10
Q

drugs used in alcohol misuse

A

benzodiazepines
disulfiram
acamprosate

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11
Q

benzodiazepine for alcohol misuse management

A

acute withdrawal

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12
Q

disulfiram for alcohol misuse management

A

promotes abstinence - alcohol intake causes severe reaction due to inhibition of acetaldehyde dehydrogenase.
Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms.
Contraindications include ischaemic heart disease and psychosis

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13
Q

acamprosate for alcohol misuse management

A

reduces craving, known to be a weak antagonist of NMDA receptors, improves abstinence in placebo controlled trials

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14
Q

history for acute alcohol intoxification

A

Unreliable

GI upset/ bleeding

Withdrawal fits

Blackouts

Peripheral neuropathy

Low mood, hallucinations, delusions, memory problems

Marital, work, driving, debt, criminality

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15
Q

CAGE questionnaire

A

Cut down

Annoyed

Guilty

Eye-opener

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16
Q

differentials for acute alcohol intoxification

A

Head injury

Hypoglycaemia

Post-ictal confusional states

Hepatic encephalopathy

Meningitis

Encephalitis

Intoxification with other drugs

17
Q

management of acute alcohol intoxification

A

violent patients
comatose: protect airway, exclude hypo, XRAY/CT head
alcohol induced hypoglycaemia

18
Q

features of alcohol withdrawal: within 12 hours of stopping

A

Anxiety

Restlessness

Tremor

Insomnia

Sweating

Tachycardia

Ataxia

19
Q

management of alcohol withdrawal

A

Diazepam 5-10mg

Or chlordiazepoxide 10-30mg

Inpatient detoxification

20
Q

features of delirium tremens

A

> 48 hours after stopping

Significant autonomic hyperactivity

Tachycardia

Hyper-reflexia

Hypertension

Fever

Visual/ tactile hallucinations

Sinister delusions

Disorientation

Confusion

Deaths from arrhythmias, infection, fits or cardiovascular collapse

21
Q

management of delirium tremens

A

Monitor

BMG

IV diazepam

Refer to medical team

22
Q

alcohol withdrawal fits mechanism

A

chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors

alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)

23
Q

features of alcohol withdrawal fits

A

symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety

peak incidence of seizures at 36 hours

Self-limiting grand mal seizures

peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

24
Q

management of alcohol withdrawal fits

A

patients with a history of complex withdrawals from alcohol (i.e. delirium tremens, seizures, blackouts) should be admitted to hospital for monitoring until withdrawals stabilised

Check BMG and treat fits

Examine for head injury

first-line: long-acting benzodiazepines e.g. chlordiazepoxide or diazepam. Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol

carbamazepine also effective in treatment of alcohol withdrawal

phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures

25
Q

alcoholic ketoacidosis features

A

Metabolic acidosis

Elevated anion gap

Elevated serum ketone levels

Normal or low glucose concentration

1-2 days after last binge with vomiting

Signs of chronic alcohol misuse

High anion gap for metabolic acidosis

26
Q

management of alcoholic ketoacidosis

A

The most appropriate treatment is an infusion of saline & thiamine. Thiamine is required to avoid Wernicke encephalopathy or Korsakoff psychosis.

Monitor UE and glucose

27
Q

wernicke encephalopathy features

A

nystagmus (the most common ocular sign)

ophthalmoplegia

ataxia

confusion, altered GCS

peripheral sensory neuropathy

28
Q

invesitgations of wernicke encephalopathy

A

decreased red cell transketolase

MRI

29
Q

management of wernicke encephalopathy

A

The treatment is with high-dose intravenous thiamine which is usually given as Pabrinex IV.

Left untreated, the condition can progress to Korsakoff’s syndrome. This syndrome affects the mammillary bodies to cause irreversible deficits in anterograde and retrograde memory.

30
Q

korsakoff syndrome

A

anterograde amnesia: inability to acquire new memories

retrograde amnesia

confabulation

Untreated, Wernicke’s encephalopathy can progress to Korsakoff’s syndrome.Korsakoff’s syndrome presents as profound anterograde amnesia with limited retrograde amnesia. Patients may therefore confabulate (fabricate memories to mask the memory deficit).

Emergency Medicine xx (16 decks)

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