1.  A young male (? early 20s) is BIBA  He presents with agitation and rapid speech  He is hypertensive -160/110, HR 140, sweating with psychotic features: paranoid and hypervigilance Emergency Department Case Study A (1) Outline (from Mabbutt & Berendsen SSWAHS)

2. 1. What Triage category would you put this person in? 2. What are the different diagnoses 3. You find out he has been injecting ‘shabu’, how do out find out what it is? 4. How will you manage his nursing care? 5. Where could you find advice on how to manage this situation? Emergency Department Case Study A (2) Questions – in small or large group(s)

3. This case study is best conducted with an Emergency Department (ED) nurse, preferably an CNS, CNE / CNC 1-2. These should be facilitated by the ED nurse 3. Shabu is a street name for Methamphetamine/‘Ice’. Even D&A experts will hear names of drugs they haven’t heard before. (See Guidelines Chapter 4 and Appendix 6 – street names of drugs, refer also to Local D&A Services or Alcohol & Drug Information Service (ADIS – 24/7) on 9361 8000 or 1800 422 599) Emergency Department Case Study A (4) Brief guide to answers for the questions

4. 4.Answer with ED Nurse, a thorough mental health/suicide/risk assessment & drug & alcohol assessment, reassurance/support, information re withdrawal & signs & symptoms, monitor withdrawal symptoms & signs, look for other causes & seek medical advice/assessment – diazepam is the likely drug of choice if symptoms escalate, keep in mind basic nursing and safety principles, & continue to look for other causes (see Chapters 6 & 9.4 in the guidelines refer to Guidelines Chapter 9.4) 5.Local D&A services & Specialist D&A Advisory Service 1800 023 687 24hr – if the symptoms of intoxication increase utilise Emergency & Mental Health specialist staff Emergency Department Case Study A (5) Brief guide to answers for the questions