Drugs & AlcoholIn the Emergency Department

Dr Sam PerryEmergency Medicine Consultant

Western Infirmary Glasgow

History of Emergency Medicine

• Referred to as Casualty/A&E/Em Med

• Casualty derived from ‘casual’

Workhouse term for:Workhouse term for:‘‘ irregular & unexpected caller whoirregular & unexpected caller who

may need temporary help’may need temporary help’

Attendances at Emergency Department

Proportion of Alcohol/ Drug related attendances

• September 2008-February 2009

• GRI& WIG 67,000 new attendances

• Total of alcohol/drug/deliberate self harm2,730 (4%)

• Illicit drug use 193 (0.2%)

• Alcohol 1,372 (2%)

• Opiate overdoses 73

All Attendances by age

0

10

20

30

40

50

60

70

0-14yrs 15-44yrs 45-64yrs 65+yrs

all attendances

sample population

Reasons why figures are probably an underestimate

• Diagnostic recording system

• Doctors choose ‘best guess’ diagnosis

• Do have an option to add more diagnoses but don’t

• System is not very user friendly

Attitudes of ED staff

• Often negative

• Patients also report attendances as a negative experience

• Very little undergraduate education

• Attitudes become more positive following education

Many drug related conditions will not be included

DVT

Abscess

Trauma

Blood Born Viruses

Cocaine use

Case History

• Standby call

• 17 year old girl

• 38wks pregnant

• ‘Fitting’

• Had taken 6 E’s earlier that evening

• Eclampsia

• Ecstasy poisoning

• Seizure

Ecstasy PoisoningHypertension

Seizures

Confusion

Nausea/abdo pain

EclampsiaHypertension

Seizures/coma

Confusion

Proteinuria

Epigastric pain

Drug related deaths & attendance in the ED

0

10

20

30

40

50

60

70

2003 2004 2006

% DRD attending ED

Number of contacts

2003 2004 2006

Range 1-35 1-17 1-14

Mode 1 for all years

Attendances prior to death

0

5

10

15

20

25

30

35

40

45

3months 3-6months 6-9months 9-12months

2003

2004

2006 Number of those attending with OD prior to death

0

2

4

6

8

10

12

14

16

1week 3months 12months

number(n=15)

Lessons

• Perception that drug users place a drain on emergency services not true

• Alcohol much more of a problem

• Only a minority of those who die present to ED prior to death

• Staff should identify drug users presenting with other conditions & refer to appropriate addiction team