frudensia-pemicu5KGD

8/18/2019 frudensia-pemicu5KGD

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Frudensia Kristiana

405110031

Group 10

Problem 5“Emergency Medicine Bloc!


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"iagnosis Multia#ial$PP"% &&&'


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"a(tar Kategori "iagnosisF0 ) Gangguan Mental *rgani+ ,ermasu Gangguan Mental

-imtomati

F1 ) Gangguan Mental dan Perilau .ibat Penggunaan /at Psioati( F10 ) Gangguan mental dan perilau aibat penggunaan aloolF11 ) Gangguan mental dan perilau aibat penggunaan opioidaF1 ) Gangguan mental dan perilau aibat penggunaan anabinoida

F13 ) Gangguan mental dan perilau aibat penggunaan sedati2a atauipnotiaF14 ) Gangguan mental dan perilau aibat penggunaan oainF15 ) Gangguan mental dan perilau aibat penggunaan stimulansia lain

termasu a(einF1 ) Gangguan mental dan perilau aibat penggunaan alusinogenia

F1 ) Gangguan mental dan perilau aibat penggunaan tembaauF1 ) Gangguan mental dan perilau aibat penggunaan pelarut yang

muda menguapF16 ) Gangguan mental dan perilau aibat penggunaan 7at multipel

dan penggunaan 7at psioati( lainnya


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F ) -i7o(renia+ Gangguan -i7otipal dan Gangguan8aam

F3 ) Gangguan -uasana Perasaan

F4 ) Gangguan 9euroti+ Gangguan -omato(orm danGangguan yang beraitan dengan -tres

F5 ) -indrom Perilau yang Berubungan denganGangguan Fisiologis dan Fator Fisi

F ) Gangguan Kepribadian dan Perilau Masa "e:asa

F ) ;etardasi Mental

F ) Gangguan Perembangan PsiologisF6 ) Gangguan Perilau dan Emosional dengan *nset

Biasanya pada Masa Kana dan ;ema


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"iagnosis Multiasial

• ,u


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.#is &Gangguan Klinis $F00>06+ F10>6+ F0>6+ F30>36+ F40>

4+ F50>56+ F>+ F0>6+ F60>6+ F66'Kondisi ?ain yang Men6'$tida ada diagnosis /03=+ diagnosis tertunda ;4='


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.#is &&&Kondisi Medi @mum

.#is &A

Masala Psiososial dan ?ingungan$eluarga+ lingungan social+ pendidian+peer


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.#is A


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.#is A Penilaian Fungsi -ecara Global $Global .ssesment o( Functioning G.F -cale' 100>61 ge1 ge1 ge1 bbrp ge51 ge41 ge31 bbrp disabilitas dlm ubungan dgn realita C omuniasi+ disabilitasberat dlm beberapa (ungsi

30>1 disabilitas berat dlm omuniasi C daya nilai+ td mampu ber(ungsi

dlm ampir semua bidang 0>11 baaya mencederai diriDorang lain+ disabilitas sangat berat dlm

omuniasi C mengurus diri

10>01 persisten dan lebi serius

0 in(ormasi tida adeuat


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"rug abuse


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ommon "rugs o( .buse


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*pioid


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*pioid Eect


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ttp)DD:::=ncbi=nlm=ni=go2Dboosel(Dpicrender=(cgiHboossamsatipCpart.4566Cblobnametip54aIg=


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Jallucionogen


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annabis


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Jo: to @seH

-moed euporic eects in minutes+Pea ) 30 minutes+?asts ) >4 ours+

Motor C cogniti2e eect ) 5>1 ours

*rally bro:nies+ caes= >3 times dose toacie2e same eect as smoed=


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.mpetamine


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"-M &A>,; ;&,E;&. F*;.MPJE,.M&9E &9,*&.,&*9

Kaplan and -adocLs -ynopsis o(


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"-M &A>,; ;&,E;&. F*;.MPJE,.M&9E 8&,J";.8.?



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Jypnotics+ -edati2es+.n#iolytics


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&nto#ication and 8itdra:al

Kaplan and -adocLs Pocet Jandboo o( linical


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,reatment o( Ben7odia7epine8itdra:al


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.lcool


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"-M>&A>,; "iagnostic riteria (or.lcool 8itdra:al

.= essation o( $or reduction in' alcool use tat as been ea2yand prolonged

B= ,:o $or more' o( te (ollo:ing+ de2eloping :itin se2eralours to a (e: days a(ter riterion .)

1= autonomic yperacti2ity $e=g=+ s:eating or pulse rategreater tan 100'

= increased and tremor 3= insomnia 4= nauseaD2omiting 5= transient 2isual+ tactile+ or auditory allucinations or

illusions = psycomotor agitation

= an#iety = grand mal sei7ures

= ,e symptoms in riterion B cause clinically signiIcantdistress or impairment in social+ occupational+ or oterimportant areas o( (unctioning

"= ,e symptoms are not due to a general medical condition andare not better accounted (or by anoter mental disorder


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9icotine


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aeine


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Withdrawal Symptoms Intoxications

Headache $o(ten described asbeing gradual in de2elopment

and diuse+ and sometimestrobbing and se2ere'Fatigue >> $e=g=+ (atigue+tiredness+ letargy+ sluggisness'Sleepiness/drowsiness >> $e=g=+sleepy+ dro:sy+ ya:ning'

Difculty concentrating >>$e=g=+ mu77y'Work difculty >> $e=g=+decreased moti2ation (ortassD:or'Irritability >> $e=g=+ irritable+

cross+ miserable+ decreased :ell>beingDcontentedness'Depression >> $e=g=+ depressedmood'Anxiety >> $e=g=+ an#ious+ner2ous'

Flulike symptoms >> $e=g=+nauseaD2omiting+ muscle

ner2ousness $an#iety'+restlessness+

e#citement+insomnia+rambling No: o( tougt andspeec+gastrointestinal upsetremors+

tacycardia+diuresis+muscle t:itcing+periods o( ine#austibility+ andpsycomotor agitation=

&n addition+ tere a2e beenreports o( patients :it caeineinto#ication a2ing (e2er+irritability+ tremors+ sensorydisturbances+ tacypnea+ andeadaces= Jig dose caeine

to#icity is 2ery rarely (atal=Jo:e2er+ caeine can be letal at


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Psyciatry Emergency


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"-M > &A

;ecent ingestionBea2ior canges $e=g= aggression'

-lurred speec

oordination

@nsteady gait

9ystagmus

O .ttention or memory

-tupor or coma


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-upport Aital -igns

Measure 2ital signs (reuently.ddress li(e>treatening problems .Bs

*( Emergency are

9o medication until are sure tey are

needed


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.ir:ay and Breating

.ssure adeuate 2entilation-traigten ead $i( no nec in


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irculation

Maintain adeuate blood pressure-tart &A line@se large>gauge needle

@se a slo: drip until no: i( need Nuids


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-peciIc "rugs ) .ntidotes

*pioids R nalo#oneMonitor possible opioid abstinence syndrome

B"/ R Numa7enilMonitor possible sei7ures C S intracran press

.tropine>lie drugsR pysostigmine

Barbiturates R 9o antidoteForced diuresis C alalini7ation o( urine


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GE*ME,;&.? J.?@&9.,&*9


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Brain &n2ol2ement


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Jeroin

Jeroin enters te brain+ con2erted tomorpine+ binds to opioid receptors$located in brain+ body+brainstem' aectsperception o( pain+ and alter breating+ BP+

J;+ arousal+ etc;egular eroin use tolerancedecreased pysiological andpsycological eect o( drug more eroin

needed to reac te same intensity o(eect

9ational &nstitute on "rug .bu


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Mari


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?-"

"isrupting interaction o( ner2e cells andneurotransmitter serotonin impairscontrol o( bea2ioral+ perceptual+ andregulatory systems+ including mood+

unger+ body temperature+ se#ualbea2ior+ muscle control+ and sensoryperception

&mpairs glutamate receptors impairs

perception o( pain+ responses to teen2ironment+ and learning and memory=



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.mpetamine

Binds to serotonin transporter

prolongedserotonin signal

Enters serotonergic neurons releasemore serotonin

-erotonin is a neurotransmitter tat playsan important role in te regulation o( mood+sleep+ pain+ appetite+ and oter bea2iors=



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Metampetamine

&ncreases te release and bloc tereuptae o( dopamine euporia

ronic abuse reduced motor sills andimpaired 2erbal learning+ se2ere structural

and (unctional canges in areas o( tebrain associated :it emotion and memory cogniti2e and emotional problems


-edati2es+ Jypnotics+


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-edati2es+ Jypnotics+.n#iolytics

Binds to G.B.. receptors

increaseaTnity to G.B. increase te No: o(cloride ions torug te cannel into teneuron

G.B. stimulation results less cloride inNutan :as caused by G.B. stimulationbe(ore ben7odia7epine administrations tolerance and dependence



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Ecstasy

Binds to serotonin transporter

prolongedserotonin signal

Enters serotonergic neurons releasemore serotonin

?esser eect in dopamine.(ter drugs use ) con(usion+ depression+

sleep problems+ drug cra2ing+ and se2erean#iety

ronic ) impairs cogniti2e ability



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.lcool

9o single molecular targetsEects on membranes o( neurons-ort term ) increasing Nuidity o( te

membranes

?ong term ) membranes become rigi


JarrisonLs Principle o( &nternal Medicine 1t Ed


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.lcoolLs .ect on te Brain

Alcoholism shrinks the brain


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"iagnosis


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Eyes8atering eyes occur during opiate :itdra:al=

Pin>point pupils suggests te recentadministration o( opiates=

"ilated pupils occurs in opiate :itdra:al+ and:ic also occur (ollo:ing te use o(ampetamine+ cocaine+ allucinogens $?-"'+ andanticolinergic drugs $in some *, drugs'=

9ystagmus is indicati2e o( into#ication :it

sedati2e ypnotics;ed eye $dilatation o( con


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Mout"ental caries is (reuently (ound in opiate

dependent users $due to poor dental ygieneand predilection (or s:eet (ood'=

?oss o( se2eral teet may occur in te courseo( con2ulsions during sedati2e ypnotic:itdra:al=Breat odour may indicate sol2ents or

alcool abuse=


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-inGooseNes $pilo>erection' indicates opiate

:itdra:al=Pro(use s:eating indicates :itdra:al (rom

sedati2e>ypnotics and alcool=-cars o( abscesses o2er any:ere o( te

body

9eedle puncture mars in te sin o2erlying

te 2eins o( in


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9euromuscular system ,remor and muscle t:itcing are signs o(

opiate :itdra:al=-e2ere :asting o( te muscle occurs :en

drug lie petidine is repeatedly in


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?aboratory E#amination

"rug test lab management include)-creening test-ee te presence D absence o( te substance D

metabolite

Kno:ing te type o( substance D metabolitecontained-etting presence D absence complications

due to drug use


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?aboratory metod (or screening drugs and ismetobolit must a2e te (ollo:ing reuirements)

-ensiti2ity and speciIcity ig sensiti2e)Being able to detect presence or absence o(

substance metabolite types o( drugs in urine

-PE&F& ,ools D reagents are able to identi(y te type o(

drug tat is in te urine= ,e metod meets tet:o conditions are)

E&. $en7yme immunoassay' and &munoromatograIMoreo2er bot metods a2e a common simple

tecniue (or screening


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,e ad2antage o( using imunoromatograItecniues)Easy to doFast results $3>10 minutes'

-peciIc $standards 9ational &nstitute o( "rug.buse 9&".+ no: -.MJ-.'-ensiti2ity up to 66=U


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$ase-aturation competition &gG anti>drug

containing en7yme substrate $antibodies':it en7yme drug in urine samples to be

screened $antigen' ,is test is a ualitati2e


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;esult@rine sample $V'-aturation occurs+ meaning tat &g G anti>

drug containing en7ymes can not bind to te

en7yme o( te drugs e#amined=9o color cange=

@rine sample $>'-aturation does not occur+ it means &g G anti>

drug containing en7yme could bind to (ull orpart by en7ymes o( te drug :ere e#amined=

&t canges color=

-ingle "etection o( "rugs and


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g gMetabolites

*nly detect one type o( drug ,E-, -,;&P D -,&K .llo: samples and reagents at room

temperature=

;eagents opened sortly be(ore done"ip tesstrip into te urine sample= "o not

e#ceed te ma#imum limit sign on te strip;ead te results o( te Irst 3>5 minutes and

3>5 minutes bot


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%est &ard ?et te samples and reagents at room

temperature=;eagents opened sortly be(ore done

Put 3>5 drops o( urine samples in te sample7one

;ead te results o( te Irst 3>5 minutes and3>5 minutes bot


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&nterpretation o( ;esults

'ositi"eForming a pin line on te 7one + so:ed drug

le2els abo2e te tresold 2alue

(egati"e ,ere are t:o pin lines on 7one , $test' 7one

and $control'

&t could mean)

9o drug substances in te urine?e2els belo: te tresold $cut o point' tat can

be detected by te test tool i( dubious conIrmation


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&n2estigations

>ray,>scan

EKG


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omplication

&n(ection J&A+ epatitis+ and tuberculosis ,racs+W 2isible puncture scars+ are caused

by repeated in


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Prognosis

0U e#posure to to#ins can be treated andremo2ed

10U admitted to &@

9on to#ic e#posure or ligt can o(ten be

sent omePsyciatric consultation i( tere is an

attempt to commit suicide


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""

)pioidJypoglycemia

Jypo#ia

&ntracerebral

emorrage.lcool into#ication

Jepaticencepalopaty

JypotermiaJyponatremia

sei7ures

$arbiturat

.lcool into#ication

Ben7odia7epin into#ication

-epsis

sei7ures


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""

$en*odia*epins.lcool into#ication

Barbituratinto#ication

JypoglycemiaMeningitis

-epsis

Halusinogen

"elirium

-i7o(ren Jead in

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