Tag Archives: mental-health

ICE Drug Bust.Good News for Emergency Departments.



Police have seized 585 kilograms of ICE in a Sydney drug bust. Most people probably hear the news and not give it much thought once the news reader moves onto the next story. But the reality is, even if you are not touched directly by drug abuse on a daily basis, it will have a huge impact on the whole of our community, socially and financially. Ultimately this drug would have been destined for distribution to the rest of Australia and I for one think it should have a big impact on the number of aggressive and psychotic patients that present to our Emergency Department for the next few months, hopefully longer.

ICE is the purest form of crystal meth. It is extremely addictive. And it is one of the causes of the presentation of aggressive patients to our Emergency Department. Patients who have ingested ICE are usually sleep deprived, some not having slept for days. They are out of control, paranoid, hallucinating, itching or picking at their skin, aggressive, malnourished, have high blood pressure, an increased heart rate, dizziness, headache, possibly fever from infection due to non-sterile injecting habits and may have also injured themselves as a result of aggression or the inability to make reasonable decisions for themselves.

Patients with these symptoms are usually brought into the department by the police. Often against their will, but in this condition we have a duty of care to reasonably detain them for their own safety and for the safety of others in the community. As you can imagine this creates a highly volatile situation. However it is a very common presentation in our department and we have very good and well rehearsed strategies, policies and procedures in place to ensure the smooth running of these situations. We have excellent resources which range from the police, our security staff, registered nurses, mental health nurses and experienced senior doctors. We also have a designated place for this type of patient to go to initially. Consideration is given to the presenting patient’s safety, the safety of other patients in the department and the safety of all staff involved in the situation.

If the patient is unable to be verbally de-escalated or refuses oral medication as part of this strategy then the medical management of this situation is a chemical sedation process (medication) either intravenously or intramuscularly, to relieve the patient from  some of the symptoms and to create a safe environment for all others. We can then proceed to treat the physical condition of the patient. The patient will at this time be asleep.

The patient then spends many, many hours in the Emergency Department and when all the medical issues are resolved and the patient is awake and alert and not requiring admission for a medical reason they then receive a mental health assessment. ICE use affects a persons mental health by causing psychosis, which involves delusions, hallucinations and distorted perceptions of reality. Which if prolonged can lead to a diagnosis of schizophrenia. ICE use worsens existing mental health problems and affects the users ability to work and maintain an adequate financial situation. It affects relationships and families and can lead to homelessness in a downward spiralling cycle of circumstances.

So you can see why it is such a great thing that  585 kilograms of ICE has been prevented from reaching the streets and will never make it into the hands of the sons, daughters, mothers and fathers of our society. Beside the four hundred million dollar street value cost attributed to this seizure it will save our communities hundreds of thousands of dollars in costs related to law enforcement, ambulance services, medical care, mental health program’s, family breakdown, crime’s committed to pay for the habit and probably a lot of other things that I cannot even begin to imagine.

This is not meant to be a definitive treatment plan or a tool for educational purposes.

The majority of people don’t need to deal with this type of thing on a daily basis at work and probably don’t realise the impact of this on the individuals who do. Do you have an example of an experience with someone on Ice or another drug? I would love to hear about it.

Stay safe, be happy,

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Where is the off switch?


brain-cogs1Have you ever had that moment when you do something only to realise that it probably wasn’t well thought through. At the time and in the moment you were focused on getting something done, only to realise down the track it probably wasn’t done in the smartest way. I had one of those moments recently.

It happened with a patient that had just had six minutes of cardiopulmonary resuscitation (CPR) and was intubated (Had a tube into their airway and a machine breathing for them) after taking an overdose, so needless to say it was in a highly stressful situation. At the time “the resus” didn’t seem like such a big deal, but on reflection not too many people do this sort of thing on a regular basis at work, and yeah it actually was very a stressful situation. The event I am talking about was minor, easily resolved and not even an issue EXCEPT that I felt like such an idiot.  I knew at the time, that a bigger problem for me would be the amount of time I would spend berating myself about it and going over and over it in my mind.

I thought about it for the rest of the shift. I thought about it walking to my car, driving home, whilst I was NOT going to sleep. It was the first thing I thought about the next morning, whilst having my shower, making breakfast, etc etc, you get my point.

I cannot help it. I go over and over stuff like this in my head. And it sucks. I’m wondering if others do this? I’m wondering how to stop it, because it takes more than just telling yourself to stop it. All my logic tells me it was no big deal, could have been worse, nobody died. Then I have a crisis of confidence and I think “I shouldn’t be doing this job and I should get a job where I have no responsibility.”  Deep down I know this isn’t necessary or true and that I’d be bored stupid. And that I’m actually pretty good at what I do but none of this helps at the time.

I know there are personality types out there who would be reading this and thinking, what is she talking about, get over it and yourself. But what I would like to do is find a happy medium. Care enough to take the time to reflect on the action or incident, learn from the experience and move on. Stop the churning. I know I’m one extreme but I think the other extreme would be just as bad. I would hate to be dangerous because I believed I could do no wrong.
I debated actually posting this blog. I’m a bit embarrassed about admitting this in such a forum, as it’s probably not something you would openly discuss amongst work colleagues, but I think there must be people out there who go through the same doubts as I do after something like this. I am finding out through feedback about my blog that there are always people who can relate to the things I write about, so I have decided to go ahead and post this because if you too are a someone who goes over and over situations like this, you are not alone. Or maybe it is just me, alone?
So now I have written about it and I am hoping this helps. Writing this blog is my own therapy as you know, get it out of my head and onto the “page”. I would really like to hear your thoughts. Are you a churner? What do you do that helps you switch off the cogs turning in your brain? I would love to hear some strategies!
Stay Safe, be happy.
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