Self Harm and Substances Flashcards by Jade Burford

ABC of self harm patients

A - assessment and analgesia
B - bloods and other physical investigations and treatments
C - circulation referring to family and wider network
DEFG - don’t ever forget safe Gaurding

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What is the 4 area approach to mental health assessment

Suicidal intent
Mental state
Risk factors and warning signs
Protective factors and suicidal mitigation
Physical health
Stop the stigma

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What mnemonic can health with taking a psychosocial history with children

HEEADSSS

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Aids to help with assessing an adults mental state

MMSE

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Drugs commonly seen in overdose

Opiates, benzos, beta blockers, aspirin, TCAs, SSRIs, CO

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Three main features to look out for in opiate overdose

Miosis (pinpoint pupils), respiratory depression, coma

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Findings that may help you identify opiate overdose

Assessment of patient, history of chronic pain with chronic opioid use, illicit drug use/dependency, needle marks

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Treatment of opiate overdose

Naloxone

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How does naloxone work

Competitively binds to same opioid receptors, short duration of action

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What can high doses of naloxone cause

Cardiotoxicity increased risk

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Which receptos do benzodiazepines work on

Enhance GABA action at GABA receptors

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What are benzodiazepines used for

Status epilepticus, spasticity, anxiety

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Presentation of benzodiazepine overdose

Drowsiness, ataxia, dysarthria, nystagmus, respiratory depression, coma, can have normal vital signs

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Which drugs can benzos increase the effects of

Opiates or alcohol

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Treatment of benzo overdose if present within 1 hour of ingestion

Give activated charcoal

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Treatment of benzo overdose if present after 1 hour of ingestion

IV Flumazenil

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How does activated charcoal work

Decreasing rate your stomach and bowel absorb a drug

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How does flumazenil work

Benzodiazepine antagonist

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What are beta blockers used for

HTN, HF, MI, tachycaardia, glaucoma, pregnancy, anxiety, essential tremor, hyperthyroidism

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Response produced by beta-1-adrenoceptors

Increase in HR, contractlity and blood pressure

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Response produced by beta-2-adrenoceptors

Bronchodilation

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Cardiac features in beta blocker overdose

Bradycardia, hypotension, heart block, syncope and HF

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What does sotalol cause

QTc prolongation

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What does propanolol cause

QRS complex prolongation

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Non-cardiac features in beta blocker overdose

Bronchospasm, respiratpry depression Hallucinations, coma, convulsions, confusion, depression, drowsiness Hypoglycaemia, hyperkalaemia

What is an important bedside investigation which needs to be perfomed in beta blocker overdose

ECG

What to give in beta blocker overdose if present to ED within 1 hour

Activated charcoal

What to give in beta blocker overdose if present to ED after 1 hour

None needed unless complications have occured - treat complications

What to give in beta blocker overdose if present to ED after 1 hour

None needed unless complications have occured - treat complications

Treatment of QRS prolongation on ECG

IV sodium bicarbonate

Uses of aspirin

Secondary prevention of MI, stroke, DVT or PE, management of ACS and TIA

Features of aspirin overdose

Hyperventilation, tinnitus, deafness, vasodilation, sweating

Investigations into suspected aspirin overdose

Plasma salicyclate levels, paracetemol levels, ABG

How does aspirin cause overdose features in patients

Stimlates respiratory centre but inhibits citric acid cycle - less oxidative phosphorylation and increased production of lactic acid --> metabolic acidosis

What to give in aspirin overdose within 1 hour

Activated charcoal

What to give in aspirin overdose after 1 hour

IV sodium bicarb, but if severe acidosis is not responding then haemodialysis

Uses of TCAs

Anxiety, depression, neuropathic pain, migraine prophylaxis

Features of TCA overdose

Dry mouth, urinary retention, mydriasis, hypotension, arrhythmias, headache, convulsions, coma, hyperreflexia with extensor plantar response, respitatory failure, drowsiness

What investigations to conduct in TCA overdose

ABG/VBG, ECG (tachy and QRS prolongation), paracetemol levels

How do TCAs work

Increase concentration of serotonin and noradrenaline, and cause sedative and antimuscarinic effects

Treatment of TCA overdose if present after 1 hour

Treat acute complications such as IV sodium bicarb to stop QR prolongation and IV lorazepam for convulsions

How do SSRIs work

Increase the concentration of serotonin in the synapse by working on SERT proteins

Features of acute overdose of SSRIs

Agitation, tremor, nausea, vomiting, nystagmus, tachycardia, drowsiness

What is serotonin syndrome

Severe presentation of SSRI overdose needing immediate intervention

Features of serotonin syndrome

Hyperthermia, rhabdomyolysis, hyponatraemia, coagulopathy, neuropsychiatric effects, neuromuscular hyperactivity, acute renal failure, autonomic instability

Investigations for SSRI overdose

ECG, FBCs, U&Es, creatine kinase, clotting screen, paracetemol levels

Treatment of SSRI overdose presenting 1 hour after presentation

Treat complications such as prolonged QTc with IV magnesium sulphate and status epilepticus with IV lorazepam

Acute carbon monoxide poisoning features

Flushing of skin, nausea, vomiting, drowsiness, dizziness, headache, myalgia

High levels of CO poisoning features

Loss of consciousness, MI, confusion, respiratory failure, death

Chronic CO poisoning features

Dementia, dizziness, vertigo, chronic headaches, lethargy, chronic nausea, vision loss

Investigations for suspected CO poisoning

Carbon monoxide breath test, ABG/VBG, carboxyhaemoglobin levels, pulse oximeter, chest XR

Treatment of CO poisoning

Oxygenation - 15L non-rebreath mask, hyperbaric oxygen chamber (GOLD)

Complications of CO poisoning

Cerebral oedema, respiratory failure

Methods of active elimination for patients with poisoning

Urinary alkalisation, haemodialysis

What does urinary alkalisation do

Enhances urinary excretion of weak acids (aspirin, amitriptyline) by giving sodium bicarb 1.5L 1.26% over 2 hours

Indications for haemodialysis (SLIME)

Salicyclate Lithium Isopropanolol Methanol Ethylene glycol

What to give if there is persistent hypotension

Glucagon

Criteria for liver transplant in paracetemol overdose

pH <7.3, PT > 100, creatinine >300, grade 3 or 4 encephalopathy, lactate >3.5

Treatment of paracetamol overdose

NAC

Presentation of cocaine use

Agitated and signs of sympathomimetic toxidrome

Types of substances used in toxic alcohol ingestion

Ethylene glycol (anti-freeze) or methanol (anti freeze windscreen wiper).

Antidote to antifreeze intoxification

Fomepizole or haemodialysis

VBG of toxic alcohol ingestion

High osmolar gap >10, high anion gap metabolic acidosis, normal blood alcohol level

Antidote for cyanide

Hydroxycobalamin

Symptoms of alcohol withdrawal

Insomnia, autonomic dysfunction, tremor, nausea and vomiting, agitation, anxiety, seizures, hallucinations

Requirement for admission of alcohol withdrawal syndrome

Presenting with or at risk of delirium tremens, risk of seizure, frail, vulnerable or co morbidities

Complications of alcohol use disorder

Delirium tremens, Wernicke-Korsakoffs syndrome, refeeding syndrome, hepatic encephalopathy