Unit 4 Lesson 1 Substance Misuse Complications PDF

Unit 4 Medical Issues Lesson 1 Substance Misuse Complications Lesson Goal At the end of this lesson, you will be able to provide emergency first aid for a patient who has complications from substance misuse. You will also be able to administer naloxone for fentanyl and opioid overdose. Ov...

Unit 4 Medical Issues Lesson 1 Substance Misuse Complications Lesson Goal At the end of this lesson, you will be able to provide emergency first aid for a patient who has complications from substance misuse. You will also be able to administer naloxone for fentanyl and opioid overdose. Overdose ✅ HL241.1. Describe how overdose can occur Patients who misuse substances can sometimes experience complications such as overdose, which is when you take too much of a substance or more than the recommended amount that the body can safely handle. An overdose, especially an opioid overdose, can be fatal. However, symptoms will range in severity depending on the type of substance, the quantity, how a person took it, and their age and overall health. Changes in tolerance can also affect the risk of overdose. Patients who lose their tolerance for a substance after taking a break and then use the same amount as before are more at risk for overdose. Not all overdoses are a result of substance misuse. An overdose can also happen from dosage miscalculation, confusion, or accidentally using more than one substance at the same time. If you respond to the scene of a suspected overdose, the person may be using a substance for the first time or may have a history of misusing substances. Regardless of the patient’s history, it is impor- tant to recognize the signs of an overdose and respond quickly. Responding to a Suspected Overdose ✅ HL241.2. Describe the signs and symptoms of an overdose An overdose can include the following patient symptoms: pinpoint pupils blue or purplish black fingernails or lips unresponsiveness, inability to speak, but awake loss of consciousness, cannot wake up breathing or heartbeat has stopped or slowed choking sounds or snore-like gurgling Chapter 2 First Aid for Criminal Justice Officers / 123  pale or clammy face vomiting, severe stomach pain, or diarrhea dizziness, loss of balance or co-ordination, limp seizures, hallucinations agitation, paranoia Make sure that you have alerted EMS if you suspect overdose. Provide EMS with the name of the substance used in the suspected overdose, if known. An opioid overdose is primarily a respiratory medical emergency, so it is important to ensure that the patient is breathing adequately. ✅ HL241.3. Describe how to respond to a suspected overdose To respond to a patient experiencing a suspected overdose: 1. Perform ongoing assessment of the patient for life-threatening conditions based on the severity of the suspected overdose. 2. Be prepared to perform CPR and use an AED if available. Administering Naloxone ✅ HL241.4. Describe when and how to administer naloxone Opioids are a class of drugs used to reduce or relieve pain. Naloxone rapidly reverses an opioid overdose. It is available as an injection, nasal spray, and auto injector. The basics for administer- ing any naloxone delivery system is to administer a dose of naloxone every two to three minutes until the patient is breathing on their own. If using the nasal spray alternate nostrils. Follow the manufacturer’s instructions and your agency’s policies and procedures for storing, maintaining, and administering naloxone. This is the only medication that an officer can legally administer and your agency’s policy and procedures will dictate when and how you administer naloxone. Fentanyl Pharmaceutical fentanyl prescriptions are for pain management and delivered through injection, a transdermal patch, flavored lozenges, dissolving tablets, and nasal spray. Fentanyl is a synthetic opioid that mimics morphine but is up to 100 times more potent than morphine and up to 50 times more potent than heroin. Illegal labs produce illicit fentanyl and similar drugs, sometimes to use as additives to heroin. Some synthetic opioids, such as the animal tranquilizer carfentanil, can be 100 times more potent than fentanyl. Signs of fentanyl poisoning or overdose include: disorientation difficulty speaking or walking 124 / Florida Basic Recruit Training Program (HL): Volume 2  slowed pulse nausea slow, shallow breathing respiratory arrest ✅ HL241.5. Describe how to respond to fentanyl exposure The standard treatment for suspected fentanyl overdose is to administer naloxone. If exposed to the skin, remove contaminated clothing immediately. Wash the skin with soap and water for fifteen minutes, taking care not to further irritate the skin by scrubbing. Do not use alcohol, hand sanitizer, or any solvent to remove fentanyl as it can increase your skin’s ability to absorb the drug. Fentanyl Exposure Risk Level Description of Exposure Examples What You Should Do Low Risk not airborne exposure to small Put on gloves. of Exposure low quantity amount of drugs Wear long sleeves (little chance no contamination pills or capsules if possible. of fentanyl (sealed, intact Use mask and particles container) eye protection if reaching your what you appropriate. nose, mouth, would expect eyes, or getting for street-level on your skin) possession or sale Moderate Risk potential for airborne more than for Cover your of Exposure moderate quantity personal use or torso and arms. possible contamination street-level sale Double glove. potential for powder Put on a mask and eye to become airborne protection. High Risk airborne exposure to large Evacuate immediately. of Exposure high quantity amount of drugs Call a hazmat team, severe contamination near loose powder preferably a team widespread with clandestine contamination lab training. drugs concealed in Have on-site a tight space, and decontamination would be difficult to ready if possible. remove and process Have medical personnel on standby. It is important to minimize your exposure to fentanyl by choosing the appropriate PPE based on the level of risk – low, moderate, and high risk. Chapter 2 First Aid for Criminal Justice Officers / 125 Other Complications From Substance Misuse Some patients may display a group of symptoms, such as severe agitation, hyperactivity, confu- sion, intense paranoia, and hallucinations, that appear suddenly but which have short duration and require immediate attention. While you may hear this referred to as “excited delirium,” it is important to note that the term is no longer used in clinical settings. The common causes of these symptoms could be, but are not always, poisoning from stimulant drugs, especially cocaine and methamphetamine. Signs and symptoms have been described as including the following: hyperthermia, sweating incoherent shouting or (temperatures can spike to between unclear speech 105°F and 113°F) foaming at the mouth agitation drooling hyperactivity dilated pupils If you recognize these symptoms, it is important to get the patient help. Patients experiencing these symptoms need verbal calming, rapid de-escalation, and possibly medical treatment. Remove excess stimuli by turning off lights and sirens. Possible containment in a controlled and safe envi- ronment can ensure safety for everyone while the incident runs its course or prior to EMS arrival. Substance Withdrawal ✅ HL241.6. Describe how to respond to a patient experiencing substance withdrawal Withdrawal is a physical, mental, and emotional response to suddenly or slowly quitting the use of substances. If not managed medically, withdrawal from drugs such as alcohol and benzodiazepines can be severe or deadly. Symptoms of acute withdrawal or detox include: substance cravings increased sensory sensitivity anxiety or panic attacks insomnia or other sleep disturbances apathy irritability, aggression, hostility depression lack of enthusiasm or motivation fatigue or low energy poor impulse control foggy thought process poor memory impaired concentration severe mood swings increased sensitivity to stress Patients experiencing opioid withdrawal often pick at their skin as they are hallucinating that bugs are crawling on or under their skin. Alcohol and benzodiazepine withdrawal syndrome may be life threatening and requires immediate advanced medical care and management. 126 / Florida Basic Recruit Training Program (HL): Volume 2