What is emergency treatment?

Emergency Treatment Overview

A person who has overdosed on a drug requires emergency treatment. Oftentimes, this treatment is initiated by friends, family, or coworkers. Emergency rooms (ERs) can be a challenging maze for persons not familiar with them, but some characteristics are common to most ERs.

Triage yields the first ER assessment, determining illness severity. Triage
is a French word meaning “to pick or cull.” Triage nurses record information related to the patient. Any family or friends accompanying the overdosed patient can be particularly helpful at this time by providing information they have about the overdosed patient. Medications, health history, allergies, and any drug paraphernalia found with the overdosed patient can help with diagnosis. The patient’s vital signs are taken and recorded in triage, including his or her pulse, temperature, respiratory rate, and blood pressure.

Illness severity is usually broken into the following categories at triage: critical and immediately life threatening, such as a heart attack or a heroin overdose in which the patient is not breathing well; urgent but not immediately life threatening, such as most cases of abdominal pain or many cases of alcoholic intoxication; and less urgent, or the “walking wounded,” including those with lacerations, coughs, and sore throats.

The emergency treatment of addictions and substance abuse is at first concerned with treating overdoses. After treatment of an overdosed patient and after medical stabilization, secondary care is initiated. Common substance abuse problems resulting in emergency treatment include alcohol intoxication, cocaine abuse, and heroin abuse. The following information outlines what can be expected if confronted with the care of an overdosed person.

A person overdosed on alcohol will often be obtunded (that is, will have a decreased mental status and will show lethargy and stupor). He or she may be vomiting, may lack muscle coordination, or may be passed out (unconscious). Severely intoxicated persons, who sometimes have a blood alcohol content (BAC) level above 0.35 percent and as high as 0.50 percent, should be transported to an ER as soon as possible. Alcohol levels in that high of a range often mean alcohol poisoning. (Legal limits of alcohol intoxication while driving in the United States is 80 milligrams of ethanol per 100 milliliters of blood, or a BAC of 0.08 percent.) Upon arrival at the ER, the alcohol-poisoned person is first assessed in triage.

An obtunded alcohol-intoxicated patient who is still conscious would most likely be assessed as a category two patient. A person overdosed on heroin, unconscious with the pinpoint pupils characteristic of narcotic overdoses, and with a severely depressed respiratory status, would be advanced to the category one or resuscitation section of the ER. Cocaine intoxication can lead to compromised cardiovascular dynamics. In such cases, pupils are dilated (large), breathing rates speed up, blood pressure elevates, and abnormal heart rates and rhythms occur with cocaine use. A person overdosed on cocaine and with a compromised cardiovascular function would be advanced to category one for emergency care and stabilization.

Basic Stabilization

Overdose precautions taken “in the street” do not (and should not) typically include inserting a needle into the heart (as featured in films and on television). Street methods, which should not be used, sometimes include forced milk ingestion in an unconscious, narcotic-overdosed person, ice packing, or the injection of milk or saltwater (saline) solutions. Serious side effects can ensue, including aspiration pneumonia (milk vomited up from the stomach and into the lungs), hypothermia (dangerously low body temperature), blood infections, and cellulitis (skin infections).

Substance abuse overdose is a serious emergency requiring hospital treatment and evaluation. Someone trained in cardiopulmonary resuscitation (CPR) can check for a pulse in the unconscious person and initiate CPR after calling 911 for assistance; any home or street care should first be guided by accessing the emergency health care system. Recent programs have placed naloxone, a drug that treats narcotic overdoses, in the hands of nonmedical personnel so that they can treat life-threatening overdoses in the street. Training programs for this type of treatment exist in urban areas. A doctor-supervised training program organized through the Chicago Recovery Alliance, for example, has dispensed naloxone to drug users in an effort to provide lifesaving narcotic reversal on the streets.

Emergency Care

Initial ER treatment of a nonresponsive patient involves intravenous (IV) line insertion, oxygen administration, and heart monitoring. An IV provides direct access to blood vessels for medication injection and allows intravenous fluid replenishment if needed. Many obtunded overdose patients have depressed respirations, and oxygen applied through a mask or nasal cannula helps deliver oxygen to the brain and body. Cardiac or heart monitoring along with oxygen-saturation measuring devices offer valuable information related to blood transport in the body.

Emergency treatment of narcotic overdoses requires naloxone. Naloxone blocks the opiate receptors in the nervous system and reverses comas and breathing problems caused by opiates like heroin. Naloxone is rapidly effective, usually reversing the coma and respiratory depression within one or two minutes. A glucose solution is often administered intravenously to unresponsive patients to treat the possibility that low blood sugar is causing or contributing to the unconscious state.

Naloxone is helpful for narcotic overdoses, but it does not readily block alcohol poisoning. An alcoholic will be treated with IV fluids to replenish fluids and minerals and with the vitamin thiamine and multivitamins, and he or she will be observed for many hours until the excess alcohol is metabolized by the person’s liver. Generally, a person’s BAC level will drop from 0.20 to 0.10 in about five hours. This rate of metabolism will vary, and alcoholics often metabolize alcohol at a faster rate.

Cocaine overdose often leads to cardiac arrhythmias, requiring cardiac monitoring, analysis of abnormal rates and rhythms, and appropriate interventions to stabilize the heart. These interventions include IV medications or electrical defibrillation and cardioversion.

All of these treatments are subject to ongoing evaluation and reassessment. A category two alcohol-intoxicated patient could progress to a category one patient with no pulse or blood pressure, requiring advanced CPR and intervention. Narcotic overdosed patients may rapidly improve with naloxone treatments but could “crash” from secondary problems caused by the effects of multiple drug ingestions or by underlying heart, lung, kidney, or brain problems.

Emergency treatment is often followed by inpatient hospitalization, depending on the problems and recovery course. Follow-up care with substance abuse treatment centers is necessary to prevent recurrence of these life-threatening overdoses.

Bibliography

Capriccioso, Richard P. “Emergency Rooms.” Magill’s Medical Guide. Ed. Brandon P. Brown, et al. 6th ed. Pasadena: Salem, 2011. Print.

Marx, John. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia: Mosby, 2010. Print.

Samet, J. A. “Drug Abuse and Dependence.” Goldman’s Cecil Medicine. Eds. Lee Goldman and Andrew I. Schafer. 24th ed. Philadelphia: Saunders, 2012. Print.

Terry, Don. “A Shot That Saves the Lives of Addicts Is Now in Their Hands.” New York Times. New York Times, 24 July 2010. Web. 6 Mar. 2012.