Tegretol

By P. Ballock. Bridgewater College.

Even though the effects of purulent material and debriding (remov- inhalants are brief purchase tegretol 400 mg overnight delivery, their use can result in ing) the area of dead tissue buy 200mg tegretol with visa. No specific medical treat- usually prescribed, especially if individu- ment is usually indicated for inhalant als demonstrate systemic symptoms. An acute inflammation of the tissues without necrosis (tissue death) is called cellulitis. When associated with intra- MEDICAL CONSEQUENCES OF venous drug abuse, cellulitis is caused by ABUSE OF OTHER DRUGS AND the invasion of a variety of organisms or SUBSTANCES by irritation of the tissues from the drug itself. The tissue becomes red and tender, Substance abuse leads to psychological, and there may be adenopathy (swelling social, and vocational impairments and of- of lymph nodes). Treatment of cellulitis 220 CHAPTER 7 CONDITIONS RELATED TO SUBSTANCE USE depends on the cause. If the fibrous changes are extensive, they affect the oxygen-exchanging abili- Injections with nonsterile needles or in- ty of the lungs. Symptoms similar to those jections of drugs that have been contam- of emphysema may develop. Changes in inated by adulterants may leave needle lung elasticity can eventually result in pul- track scars. Injections cause a mild inflam- monary hypertension and subsequent heart matory reaction and, with subsequent failure. Injection of a drug into an artery ter 11 for a discussion of pulmonary hyper- instead of a vein can cause an extreme tension and heart failure. If not treated occur if organisms localize in the lung after properly, gangrene may develop, necessitat- the nonsterile injection of a substance. Aspiration pneumonia, an inflammation of the lung, may result from the inhalation Cardiovascular Complications of foreign substances or chemical irritants. Aspiration of gastric contents is also a Other than direct effects on the heart common cause of aspiration pneumonia. Rather than being a direct can lead to potentially serious conse- result of drug use, tuberculosis is more quences (see Chapter 11). In some instances, inflam- poor hygiene, and overcrowding all con- mation of the veins with clot formation tribute to development of the disease. In (thrombophlebitis) may occur because of addition, because some drugs have an im- the toxic effects of the drug. An Respiratory Complications overdose of narcotics or sedative/hypno- tics can severely depress the respiratory The intravenous injection of drugs to center, causing cessation of breathing and which adulterants such as talc, starch, or consequent death. Overdoses of narcotics baking soda have been added may result have also been associated with develop- in pulmonary complications. Because ment of severe pulmonary edema (collec- these substances do not dissolve, they cir- tion of fluid in the lungs), which, without culate in the blood and may become treatment, can also result in death. Diagnostic Procedures 221 Gastrointestinal Complications Other Complications Because the liver acts as the detoxifica- The chronic use of some drugs may tion center for the body, individuals who result in nystagmus (involuntary eye chronically abuse drugs may damage movement). Chronic, excessive abuse of sol- renal failure, which can progress to per- vents, for example, can cause liver necro- manent kidney damage (see Chapter 13). Other substances may Individuals who abuse drugs also have a cause liver abnormalities such as inflam- higher incidence of venereal disease, such mation or fibrosis. Hepatitis A may be related to of the most serious and hazardous com- poor hygiene habits and poor envi- plications of drug use in the past few ronmental conditions. More commonly, years has been infection with HIV (see hepatitis B (serum hepatitis) occurs as the Chapter 8), which is related to both in- result of nonsterile or contaminated intra- travenous drug use and unsafe sexual venous injections. HCV causes what was pre- fetal hazards are related to the lifestyle of viously called non-A, non-B hepatitis and the mother, which results in poor prena- is transmitted through infected blood. The direct toxic effects travenous drugs and share needles are at of drugs on the developing fetus (tetrato- high risk for developing the disease. Diagnosis of substance use disorders is often delayed or symptoms overlooked.

Epidural hematomas carry a high cording to the level of response in each of mortality rate because they may not be three areas: eye opening tegretol 400 mg mastercard, motor response buy discount tegretol 200mg, immediately recognized and consequent- and verbal response (Table 2–2). A subdural hematoma is a hemorrhage The lower the score, the deeper the level of that occurs in the space beneath the dura unconsciousness. Although symptoms may be appar- provides a means whereby individuals’ ent immediately, they may also appear level of consciousness can be assessed sys- more gradually, becoming evident days or tematically. In both a baseline from which changes in neuro- instances, immediate action is essential to logical status can be measured. The scale is stop the bleeding and to relieve the usually used in the early postinjury period intracranial pressure before permanent in the emergency and critical care units. Another scale used to measure level of brain injury is the Rancho Los Amigos Cog- Measuring the Severity of Traumatic nitive Scale. The scale basically describes Brain Injury levels of arousal and cognitive function- ing. It measures increasing levels of con- A variety of instruments are available to sciousness, so it often is used to give a measure the severity of TBI. These instru- gross indication of stages of recovery after ments are used to predict the condition of brain injury. The range of the scale is from the individual after discharge and can be 1 to 8, with higher scores indicating high- useful measures for rehabilitation services er functional level. In the treatment and after hospitalization (Wagner, Hammond, rehabilitation phase after injury, individ- Grigsby, & Norton, 2000). The Ranchos • moderate Los Amigos Scale of Cognitive Function, • severe as a measure of cognitive function, is usu- One basis of classification is the length ally used to assess changes in the level of of time the individual is unconscious after consciousness during the postinjury peri- injury and the depth of unconsciousness od and as a broad indicator of the extent Conditions Affecting the Brain 35 to which independent functioning is pos- sible. In this way a specific treatment can Table 2–3 Rancho Los Amigos Scale of be instituted to promote appropriate Cognitive Functioning behavior as the individual moves through different levels (Table 2–3). Level II Generalized response to stimuli, Table 2–2 The Glasgow Coma Scale such as responding to a loud noise but not turning toward the noise. Category Score Movement is not consistent and does not appear to have a purpose. When Eyes open eyes are open, they do not appear to Never 1 be focusing on anything in particular. The individual To verbal stimuli 3 begins to open eyes and look at Spontaneously 4 specific objects. Simple None 1 commands are followed, such as Incomprehensible sounds 2 “squeeze my hand. The indi- Disoriented and converses 4 vidual becomes very restless and Oriented and converses 5 agitated regardless of the circum- Best motor response stances. The individ- Extension (decerebrate rigidity) 2 ual may become verbally abusive. Flexion abnormal (decorticate rigidity) 3 Level V Confused, with conversation often Flexion withdrawal 4 not making sense. The individual Individual localizes pain 5 appears confused although may be Individual obeys 6 able to follow simple instructions. Some memory problems The Disability Rating Scale (Rappaport, regarding recent events may be Hall, Hopkins, Belleza, & Cope, 1982) is present. Capable of most self-care also used to estimate functional capacity activities. The scale evaluates indi- lem-solving difficulties, but the indi- viduals on eight categories of disability vidual is often aware of this deficit. Physical, cognitive, • Psychosocial adaptability, including or psychosocial deficits may last for weeks flexibility and ability to adapt to dif- to months or may be permanent. Brief loss of consciousness (30 minutes which there is at least one of the symp- or less) toms as listed in Table 2–4. Brief period of time after the injury with mild brain injuries have a Glasgow during which the individual feels Rating of 10 or above and may have few stunned and disoriented if any outer signs of brain injury or no 3. Loss of memory for events occurring detectable anatomic damage to the brain. Initial Glasgow Coma Scale score of disruptive symptoms that persist months 13–15.