Changing the Care Environment for Acute Intoxication: Providing Intoxicated Adults With an Alternative to the Emergency Department and Jail

2021 ◽  
Vol 82 (5) ◽  
pp. 678-684
Author(s):  
Shannon Smith-Bernardin
Author(s):  
Enno Freye

While amphetamine and especially methamphetamine (speed) is being misused by all social classes in order to increase stamina, intellectual expansion, endurance, and euphoria, the drug 3,4-methylenedioxy-N-methylamphetamine (MDMA) (ecstasy) is preferentially abused by the younger generation for the feeling of empathy, the touching within, and enhancement of the senses. Acute intoxication differs in regard to their effects on the person. The predominant sympathetic overstimulation after methamphetamine results in cardiovascular and CNS hyperactivity accompanied by agitation and seizures, while tachycardia is a prodrome of fibrillation. The excess hypertonia often leads into myocardial infarction and may even induce cerebral haemorrhage. MDMA intoxication often seen in the emergency department is predominantly characterized by hyperthermia, the most important condition to treat, followed by rhabdomyolysis and acute renal failure. Since there is no specific antidote available, in both cases therapy consists of treatment until the acute effects are gone.


CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S32-S32
Author(s):  
H. Murray ◽  
L. Erlikhman ◽  
T. Graham ◽  
M. Walker

Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visits among youth. We sought to quantify the impact of ED visits (type and frequency, patient characteristics and resource use) related to alcohol in our centre. Methods: This was a chart review of patients aged 12-24 with alcohol-related ED visits between Sept 2013-Aug 2017. The National Ambulatory Care Reporting System (NACRS) database was searched for visits alcohol related ICD-10 codes. The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) database was also searched using the keyword alcohol. Duplicate visits were removed. Visits were excluded if patients had a history of psychosis, were held in the ED for psychiatric assessment, were homeless, were inmates from a correctional institute, if alcohol use was not mentioned and for complaints of sexual assault/intimate partner violence. Data was abstracted by two reviewers using a standard form with predetermined variables. Differences were resolved with third party adjudication. Interrater reliability of the reviewers was assessed with Kappa scores through duplicate review of 10% of randomly selected charts. A further 10% were assessed by a 3rd reviewer for extraction accuracy. Results: 3,256 ED visits were identified with 777 removed via predefined exclusion criteria. 2,479 visits were reviewed with a male predominance (54.3%). More than half of all patients (50.9%) arrived via ambulance. Assigned CTAS levels were Resuscitation: 1% Emergent: 9.9% Urgent: 48.2% Less Urgent: 35.7% Non-Urgent: 4.2% (missing 1%). The median LOS was 2.9 hrs (IQR 1.8-4.6). All visits were subclassified into mutually exclusive categories: injury (51.8%), acute intoxication (45.1%) and mental health issue (3.2%). Males were more likely to present with injury (62.4% vs 42.6%, p < 0.01). Females were more likely to present with acute intoxication (53.3% vs 46.7%, p <0.01) and mental health issues (59.5% vs 40.5%, P = 0.01). ED resource use was notable: 483 (19.4%) had imaging tests and 1216 (49.1%) had some medical intervention (blood test, fluids or medication). 57 (2.3%) patients were admitted and there was one death from an alcohol related MVC. Conclusion: Alcohol-related ED visits by youth are common in our centre and utilize substantial prehospital and in-hospital resources. Identification of effective harm reduction strategies should be a research priority.


2015 ◽  
Vol 6 (1) ◽  
pp. 54 ◽  
Author(s):  
Ertugrul Kaya ◽  
Aylin Yilmaz ◽  
Ayhan Saritas ◽  
Serdar Colakoglu ◽  
Davut Baltaci ◽  
...  

2020 ◽  
Vol 35 (8) ◽  
pp. 338-344
Author(s):  
Joanne Kaldy

Digital therapeutics (DTx)—treatment or therapy that uses digital health technologies to spur changes in patient behavior—increasingly are making their way into the health care environment. This evolution is especially apparent as health care moves to valuebased care, silos between settings are breaking down, and data collection/analysis and teamwork play key roles. These technologies, whether they are apps, software programs, or sensors, are helping patients adhere to treatments and lifestyle changes, set and meet viable care goals, and avoid costly emergency department visits and hospitalizations. At the same time, DTx are helping practitioners ensure the best possible outcomes; streamline costs; monitor patient progress; and receive, analyze, and share data.


2005 ◽  
Vol 24 (6) ◽  
pp. 337-339 ◽  
Author(s):  
Salim Satar ◽  
Ahmet Sebe ◽  
Akkan Avci ◽  
Hasan Yesilagac ◽  
Yuksel Gokel

Experience with overdosage and toxicity with the alphaadrenoreceptor antagonists remains very limited in the literature. In this paper, the second case in the literature with doxazosin overdosage is reported. Supportive treatment was given to the patient and the patient was discharged 48 hours after admission to the emergency department.


2011 ◽  
Vol 29 (6) ◽  
pp. 467-472 ◽  
Author(s):  
R G A Ambrosius ◽  
M P Vroegop ◽  
F G A Jansman ◽  
C W Hoedemaekers ◽  
R E Aarnoutse ◽  
...  

2020 ◽  
Vol 35 (8) ◽  
pp. 338-344
Author(s):  
Joanne Kaldy

Digital therapeutics (DTx)—treatment or therapy that uses digital health technologies to spur changes in patient behavior—increasingly are making their way into the health care environment. This evolution is especially apparent as health care moves to valuebased care, silos between settings are breaking down, and data collection/analysis and teamwork play key roles. These technologies, whether they are apps, software programs, or sensors, are helping patients adhere to treatments and lifestyle changes, set and meet viable care goals, and avoid costly emergency department visits and hospitalizations. At the same time, DTx are helping practitioners ensure the best possible outcomes; streamline costs; monitor patient progress; and receive, analyze, and share data.


Sign in / Sign up

Export Citation Format

Share Document