Week 10 - Harm Reduction/PTSD

Question 1

Risk for Substance Abuse

Show me Maslow’s Hierarchy

this could be why you’re depressed or anxious

Answer 1

Question 2

Show me somatoform disorders (flow chart)

Answer 2

Somatic Symptom Disorder

▪ Functional Neurological Disorder/Conversion Disorder

▪ Illness Anxiety Disorder

Question 3

Fabricated Illness/Munchausen’s

Syndrome

What is it?

What is facitious by proxy?

Answer 3

Unconscious / mental disorder

Seeking Attention / sympathy

Wants extensive testing

Factitious Disorder formerly known as Munchausen’s

By a parent to a child (child abuse) or
child to an elderly parent (elder abuse). Formerly
Munchausen’s by proxy.

Question 4

Malingering

What is it?

what do patient often do?

Answer 4

Intentionally falsifying medical symptoms (goal oriented)

Fakes or exaggerates symptoms

Want time off work (sick note)

WSIB claims that are untrue

Pain medications like opiods

travel to different locations to avaoid ditection

Question 5

Fibromyalgia

What is it?

Show me

Answer 5

a condition that causes extensive musculoskeletal pain, as well as fatigue, sleep,
cognitive, and mood problems. It increases pain sensations by altering how the brain and spinal cord interpret painful and non-
painful signals.

Question 6

Why do people call 911?

What are the top 10 ‘addictions’?

Answer 6

Toothache

Lonely

Sore finger / smashed in car door (Munchausen’s syndrome ?)

Ran out of their medication

Drug Addiction

Alcoholism

Depression & Anxiety

Social Media

Drugs

Alcohol

Food

Gambling

Sex

Pornography

Video Games

Shopping

Adrenaline “Junkies”
Anything else that stimulate dopamine release

Question 7

Addiction

What are the 4 C’s?

What are the S+S of substance use?

Answer 7

Craving

Loss of Control of amount of frequency

Compulsion to use or engage in activity

Action or use despite Consequences

injuries while under the influence

feelings of anxiety, irritability or depression

trouble thinking clearly

blackouts

problems with relationships
spending money on substances rather than on food, rent or other essentials

legal problems related to substance use

loss of hope, feelings of emptiness

Question 8

What are the top substances used in substance abuse?

Answer 8

▪ Nicotine
▪ Caffeine
▪ Alcohol
▪ Marijuana
▪ Prescription Pills / Benzos / Pain medications
▪ Inhalants
▪ Cocaine
▪ Amphetamines
▪ MDMA (Ecstasy or Molly)
▪ LSD
▪ Heroin
▪ Steroids
▪ Food

Question 9

Dopamine Adjustment: Down Regulates

What happens

What are the S+S

What does the patient do?

Answer 9

The brain adjusts to the
overwhelming surges in dopamine
by producing less dopamine.

depressed, flat, unwell, angry, frustrated and
unable to enjoy things

The person will then need to take the drug again and again to raise the dopamine level to feel better. Which further down regulates the bodies production of dopamine.

Question 10

How does cocaine work in the body?

Answer 10

Question 11

Fentanyl & Carfentanil = Crisis

Info on Fentanyl

Steps of supportive care?

Info on carfentanil

Answer 11

100 times stronger than morphine

Excellent for orthopedic injuries

Excellent for sedation

Same risk as all opioids. Primarily respiratory depression

Airway Management
Safe positioning
Narcan
BGL
Oxygen

Used in veterinarian medicine to sedate large animals like elephants

100 times stronger than fentanyl

10,000 times stronger than morphine

Question 12

Tolerance

Withdrawal

Answer 12

Reduced reaction to a drug following repeated use

Needing more of the substance to have the desired effect

Symptoms that occur upon the abrupt discontinuation or decrease in the intake of medications or recreational drugs or alcohol.

Occurs if your body becomes psychologically or physically dependent on the substance

Question 13

Alcohol Withdrawal

Delirium Tremen’s (DT’s) + signs and symptoms

What’s the treatment?

Answer 13

Usually occurs at the 2-3 day mark

Confusion

Shaking

Shivering

Irregular Heart Rate

Sweating

Hallucinations

Hyperthermia

Seizures

Coma

Death

Benzodiazapines

Haloperidol

Alcohol (measured alcohol
program)

Question 14

Show me benzos drugs

Question 15

Harm Reduction Dispensing Units

What 4 locations are they located?

What do they contain?

Answer 15

Ottawa Public Health Site Needle & Syringe Program - 179 Clarence Street

Sandy Hill Community Health Centre - 221 Nelson Street

Somerset West Community Health Centre - 55 Eccles Street

Carlington Community Health Services - 900 Merivale Road

Sterile needles and other safer injection supplies as well as supplies for safer inhalation, and information on how to access harm reduction services

All safer injection supplies are packaged in a small biohazard container for safe disposal and safer inhalation supplies are packaged in an envelope

Each safer injection pack contains alcohol swabs, sterile
needles, steri-cups, sterile water and a tourniquet

Each safer inhalation kit contains glass stems, packs of
screens, push sticks, mouthpieces and a token

Question 16

What are the hallmark signs of Excited Delirium?

remeber NOT A CRIME

Answer 16

Extreme agitation – including fear, panic,
shouting and violence.

Delirium – hallucinations, disorientation,
confusion.

Hyperthermia – elevated body temperature,
stripping off clothing to cool down.

Superhuman strength – difficult to restrain and seemingly tireless

N: Patient is naked and sweating from hyperthermia

O: Patient exhibits violence against objects, especially glass

T: Patient is tough and unstoppable, with superhuman strength and insensitivity to pain

A: Onset is acute, witness say the patient “just snapped!”

C: Patient is confused regarding time, place, purpose and perception

R: Patient is resistant and won’t follow commands to desist

I: Patient’s speech is incoherent, often with loud shouting and bizarre content

M: Patient exhibits mental health conditions or makes you feel uncomfortable

E: EMS should request early backup and rapid transport to the ED

Question 17

What is Ketamine?

Answer 17

a medication mainly used for starting
and maintaining anesthesia. It induces a trance-like state while providing pain relief, sedation, and memory loss. Other uses include sedation in intensive care and treatment of pain and depression. Heart function, breathing, and airway reflexes generally remain functional. Effects typically begin within five minutes when given by
injection, and last up to approximately 25
minutes.

Question 18

DSM-V:PTSD Part A

DSM-V:PTSD Part B

Answer 18

Exposure to actual or threatened death, serious injury, or sexual violence
in one (or more) of the following ways:

Directly experiencing the traumatic event(s).

Witnessing, in person, the event(s) as it occurred to others.

Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family
member or friend, the event(s) must have been violent or accidental.

Experiencing repeated or extreme exposure to aversive details of the
traumatic event(s) (e.g., first responders collecting human remains;
police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through
electronic media, television, movies, or pictures, unless this exposure is
work related.

Presence of one (or more) of the following intrusion symptoms associated with the
traumatic event(s), beginning after the traumatic event(s) occurred:
– Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children
older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are
expressed.

– Recurrent distressing dreams in which the content and/or affect of the dream are related to the
traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.

– Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic
event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression
being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific
reenactment may occur in play.

– Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or
resemble an aspect of the traumatic event(s).

– Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of
the traumatic event(s).

Question 19

DSM-V:PTSD Part C

DSM-V:PTSD Part D

Answer 19

Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

– Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

– Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the
traumatic event(s).

Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or
more) of the following:

Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).

Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).

Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.

Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

Markedly diminished interest or participation in significant activities.

Feelings of detachment or estrangement from others.

Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

Question 20

DSM-V:PTSD Part E

DSM-V:PTSD Part F,G,H

Answer 20

Marked alterations in arousal and reactivity associated with the
traumatic event(s), beginning or worsening after the traumatic event(s)
occurred, as evidenced by two (or more) of the following:

Irritable behavior and angry outbursts (with little or no provocation),
typically expressed as verbal or physical aggression toward people or
objects.

Reckless or self-destructive behavior.

Hypervigilance.

Exaggerated startle response.

Problems with concentration.

Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

F = Duration of the disturbance (Criteria B, C, D and E) is
more than 1 month.

G = The disturbance causes clinically significant distress
or impairment in social, occupational, or other important
areas of functioning.

H = The disturbance is not attributable to the
physiological effects of a substance (e.g., medication,
alcohol) or another medical condition.

Question 21

DSM-V:PTSD

Answer 21

With dissociative symptoms: The individual’s symptoms meet the criteria for
posttraumatic stress disorder, and in addition, in response to the stressor, the
individual experiences persistent or recurrent symptoms of either of the following:

▪ Depersonalization: Persistent or recurrent experiences of feeling detached from,
and as if one were an outside observer of, one’s mental processes or body (e.g.,
feeling as though one were in a dream; feeling a sense of unreality of self or body or
of time moving slowly).

▪ Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g.,
the world around the individual is experienced as unreal, dreamlike, distant, or
distorted). Note: To use this subtype, the dissociative symptoms must not be
attributable to the physiological effects of a substance (e.g., blackouts, behavior
during alcohol intoxication) or another medical condition (e.g., complex partial
seizures).

▪ Specify whether
With delayed expression: If the full diagnostic criteria are not met until at least 6
months after the event (although the onset and expression of some symptoms may
be immediate).

Question 22

Life Insurance

Answer 22

Life insurance normally pays out in cases of
suicide, unless it happens during a particular
exclusionary window laid out in the policy. … Depending on the terms of the policy’s suicide clause, suicide may not be covered, but this clause is usually only in effect during the first few years of the policy.