1.  A patient presents to your small rural hospital emergency department at 7.30pm on a Saturday evening  He is sweating, c/o pain in his legs and back, he has a tremor and a temperature of 37.5, has ‘goose bumps’ and has dilated pupils  He is constantly moving in the chair unable to get comfortable, he is orientated  He says he drinks alcohol and uses a bit of heroin Rural Hospital Case Study (1) Outline

2. 1.What do you think is happening? 2.The duty doctor is caught up with a road traffic accident at another hospital site and will not be available for a while – how will you manage his nursing care? 3.Which withdrawal of the two drugs is more life threatening? Rural Hospital Case Study (2) Questions – in small or large group(s)

3. 4. If he has a seizure, could this be caused by opiate withdrawal? 5. Where could you find more information on how to manage this situation? Rural Hospital Case Study (3)

4. 1.Many possible causes but probably heroin (opiate) and alcohol withdrawal (see Guidelines Chapter 9.1 & 9.2) 2.Give good supportive/basic nursing care – inform & educate patient as appropriate about what is happening and what you think might be the cause of the distress. Take a thorough assessment (including D&A), monitor on alcohol & opiate withdrawal scales & continue to look for other causes 3.Alcohol is potentially life threatening – increase risk is untreated from the delirium tremens – opiate withdrawal is not life threatening (see Guidelines Chapter 9.1 & 9.2) Diazepam may need to be prescribed and given depending on level of alcohol withdrawal Rural Case Study (4) Brief guide to answers for the questions

5. 4.No, seizures are part of the alcohol and benzodiazepine withdrawal syndromes but not opiate withdrawal (see Guidelines Chapter 9.2) 5.Local Drug & Alcohol services and refer to NSW Drug and Alcohol Withdrawal Clinical Practice Guidelines NSW Health 2007 http://www.health.nsw.gov.au/policies/gl/2008/GL2008_011.html http://www.health.nsw.gov.au/policies/gl/2008/GL2008_011.html NSW Drug and Alcohol Specialist Advisory Service 1800 023 687 is available 24hr if local Drug and Alcohol Services are unable to provide advice Rural Case Study (5) Brief guide to answers for the questions