Use these practices to treat ED patients using "meth"

Keep in mind that patient is addicted

If the patient standing in front of you appears jittery, unable to sit still, and is continually scratching at sores on his or her face and body, it's likely he or she is using methamphetamine. "It's unfortunate to say, but we can usually tell by looking at someone that he or she is a meth user," says Sue Williams, RN, a nurse with SSM Behavioral Health Services at St. Joseph Health Center-Wentzville in Wentzville, MO.

Although ED nurses report a continuing increase in methamphetamine users, five out of six Kansas EDs surveyed lacked formal treatment protocols for these patients, according to a recent study.1

"We have had increasing numbers of meth users over the past five years," says Williams, adding that they usually come in because they are hallucinating. "When they are using, they see and hear things. That can carry over into their non-using time and scare them," she says. "They think they have a psychiatric disorder."

J. Kimberlee Bagby, RN, an ED nurse at Sutter Delta Medical Center in Antioch, CA, says she continues to see a high number of patients using methamphetamine, with users complaining of abdominal pain, rapid heartbeat, or anxiety. Some are completely delusional and need immediate psychiatric intervention.

"Meth users require some unique approaches when trying to collect necessary basic health information to treat them," she says. "Staff need to be calm, stern, and have lots of patience!"

Don't be judgmental

Williams says to be careful not to give any impression you're judging the patient. "Even though you may think they're unaware of it, they do recognize when they are being looked down upon," she says. "Treat it like any other disease." Remember that the patient isn't making rational judgments because of an addiction, she underscores.

Avoid raising your voice or glaring, says Williams, as this can be dangerous for you and the patient. "Some people feel like they shouldn't back down with these patients, but you shouldn't try to make a point that you are in charge," she says.

Remember how frightened your patient is, she says, and present the calmest possible demeanor. "They really respond so much better to gentleness — very rarely do they want to strike out at us," she says. "Try to act with them the same way you would with a frightened little kid."

ED nurses at Sutter Delta Medical Center take these steps:

Obtain a medical history, including dental care.

"Meth users tend to have 'meth mouth,' with cracked, chipped, or discolored teeth, or advanced decay," says Bagby. (See related story, below, on obtaining a history, and clinical tip, on physical assessment.)

Address dietary intake.

Since methamphetamine is a potent form of amphetamine, which can work as an appetite suppressor, many meth users tend to have a poor dietary intake, says Bagby.

Carefully review vital signs, lab work, or EKGs, which will determine the next steps in treatment.

"We are fortunate that we have a social services team to help meth users receive the necessary psychiatric care, or referrals to appropriate agencies in our county," says Bagby.

Reference

  1. Tompkins-Dobbss, Schiefelbein J. Emergency department policies and procedures for treatment of patients abusing methamphetamine. J Emerg Nurs 2001; 37:437-443.

Sources

For more information on caring for ED patients using methamphetamine, contact:

J. Kimberlee Bagby, RN, Emergency Department, Sutter Delta Medical Center, Antioch, CA. Phone: (925) 779-7273. E-mail: BagbyJ@sutterhealth.org.

Get a history from a meth user

Methamphetamine users may be euphoric one minute, but paranoid, agitated, and violent the next. "This creates a challenge to get the needed information to complete their initial health assessment," says J. Kimberlee Bagby, RN, an ED nurse at Sutter Delta Medical Center in Antioch, CA.

Methamphetamine users may minimize how much they're taking, similar to the way alcoholics often report drinking less than they actually do, says Sue Williams, RN, a nurse with SSM Behavioral Health Services at St. Joseph Health Center-Wentzville in Wentzville, MO.

"People may tell you they use it a few times a week when it's actually every day," says Williams. "Each person who interviews them gets a little clearer picture."

Methamphetamine users may become physically or verbally abusive to staff, which can complicate getting them the necessary treatment, Bagby says, adding that patients tend to hide the truth about their use of methamphetamine, the reasons for their ED visit, and their health history.

"In my experience, patients who use methamphetamine require more physical and mental energy from staff trying to treat them, compared to patients who don't use methamphetamines complaining of the same ailments," says Bagby.

It's often difficult to keep the patient focused, says Bagby, so you'll need to ask the same questions multiple times to get the needed answers. "For heavy meth users, you always have concerns about the patient's overall cardiac health due to the stress caused by long-term use of the drug," she adds.


Clinical Tip

Always have meth users don gowns

If you suspect your patient is using methamphetamine, have him or her don a hospital gown regardless of his or her complaints, says J. Kimberlee Bagby, RN, an ED nurse at Sutter Delta Medical Center in Antioch, CA. "This is necessary in order to get a complete assessment of the patient's body," she says. "Look for skin abscesses, injection sites, as well as burns from smoking meth."