1. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Chapter 27 Care of the Chemically Impaired Menu F

2. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Assessment Guide History of Past Substance Abuse l Use l Treatment l Blackouts, delirium, seizures l Family History Medical History l Co-existing physical conditions l Medications History of Past Substance Abuse l Use l Treatment l Blackouts, delirium, seizures l Family History Medical History l Co-existing physical conditions l Medications Menu FB

3. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Psychiatric History l Co-morbid problems l Treatment l Family violence l History of suicide attempts l Current suicidal thoughts Psychosocial Issues l Work record l Effect of use on relationships l Role relationships l Legal problems l Support system l Coping style Psychiatric History l Co-morbid problems l Treatment l Family violence l History of suicide attempts l Current suicidal thoughts Psychosocial Issues l Work record l Effect of use on relationships l Role relationships l Legal problems l Support system l Coping style Assessment Guide, cont. Menu FB

4. Slide Copyright © 2002 by W. B. Saunders Company. All rights reserved. Alcohol equivalents 27-4 (Fig. 27-3) Menu FB

5. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Overdose l Cardiovascular, respiratory depression l Coma, shock, convulsions, death Treatment l Lavage/activated charcoal l Vital signs l Patent airway l IV fluids Withdrawal l Abrupt withdrawal may lead to death l Detox with similar drug Overdose l Cardiovascular, respiratory depression l Coma, shock, convulsions, death Treatment l Lavage/activated charcoal l Vital signs l Patent airway l IV fluids Withdrawal l Abrupt withdrawal may lead to death l Detox with similar drug CNS Depressants Menu FB

6. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Overdose l Assaultive, grandiose, paranoid l Tachycardia, elevated BP, hyperpyrexia, convulsions l Coma, death Treatment l Amtipsychotics prn l Cooling (fever) l Diazepam (seizures) Withdrawal l Antidepressants l Dopamine agonist l Bromocriptine Overdose l Assaultive, grandiose, paranoid l Tachycardia, elevated BP, hyperpyrexia, convulsions l Coma, death Treatment l Amtipsychotics prn l Cooling (fever) l Diazepam (seizures) Withdrawal l Antidepressants l Dopamine agonist l Bromocriptine CNS Stimulants Menu FB

7. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Overdose l Respiratory depression l Coma, death Treatment l Narcotic antagonist Withdrawal l Methadone tapering l Clonidine-naltrexone detox l Buprenorphine substitution Overdose l Respiratory depression l Coma, death Treatment l Narcotic antagonist Withdrawal l Methadone tapering l Clonidine-naltrexone detox l Buprenorphine substitution Opiates Menu FB

8. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Intoxication l Paranoid ideas l Anxiety l Synesthesia l Depersonalization l Hallucinations Treatment l Low stimuli l LSD - talk down l PCP - do not talk down - Valium or Haldol - Ammonium chloride Intoxication l Paranoid ideas l Anxiety l Synesthesia l Depersonalization l Hallucinations Treatment l Low stimuli l LSD - talk down l PCP - do not talk down - Valium or Haldol - Ammonium chloride Hallucinogens Menu FB

9. Copyright © 2002 by W. B. Saunders Company. All rights reserved. l Benzodiazepines - Tapering doses l Thiamine - Prevents encephalopathy l Magnesium sulfate - Reduces seizures l Anticonvulsants - For seizure control l Folic Acid/Multivitamins - Correct deficiencies l Benzodiazepines - Tapering doses l Thiamine - Prevents encephalopathy l Magnesium sulfate - Reduces seizures l Anticonvulsants - For seizure control l Folic Acid/Multivitamins - Correct deficiencies Alcohol Withdrawal Delirium Treatment Menu B