Welcome to Farasi Drug Addiction and Infection Community
Because drug addiction affects our loved ones, including sons, daughters, mothers, fathers, husbands, wives, girlfriends, boyfriends, fiances, grandparents, aunts, sisters, nephews, nieces, cousins, friends, coworkers and fellow students, we are all a part of the community doing something to help our loved ones manage, live with, eliminate, and most importantly survive the scourge and unattended consequences of drug addiction. Besides overdose, infection is a giant unnecessary killer of a lot of our loved ones, and yet it is one of the easiest problems to manage, if its presence is identified quickly by the victims themselves, family members, friends, coworkers, caregivers and medical providers. Yes, a lot has been said about how to cut back on illegal recreational drugs including Cocaine, Heroin, Ecstasy, marijuana, meth amphetamines, etc. And yes prescription narcotics(opiates) and benzodiazepines too! The pain and anxiety medications our loved ones receive from healthcare professionals including their family physicians, primary care providers, pediatricians, pain management specialists, surgeons, emergency room physicians, hospitalists, nurse practitioners, physician assistants, among others, are great for managing pain and anxiety but how can you tell when grandma has picked up an infection like a urinary tract infection? If your father has been taking these pain meds for years, why would he all of a sudden decide to overdose? Or did he really overdose? If he overdosed, by how much, and was this deliberate or inadvertent? That brother of yours on heroin, did he really intentionally overdose on the heroin he has taken for years? When you found him passed out in the kitchen, was it because he overdosed, or did something else happen that might take time to become apparent when he shows up in the nearest emergency department? When he shows up in the Emergency Department, will the doctors, nurses, nurse practioners, physician assistants, hospitalists, critical care physicians, pulmonologists, cardiologists have a high index of suspicion for infection? Now that there is a push to curtail unnecessary or inappropriate use of antibiotics will the healthcare providers be inclined to blame the shiny object in the room(the known drug addiction) before they consider other possibilities for your brother's presentation? Why does identifying infection early matter? Like they say for heart attack patients time saves muscle, for stroke patients, time saves brain, for drug addicts with infection time saves lives! This is why everyone from the victims themselves, caregivers, and healthcare providers, should be on the look out for infection. A simple Urinary Tract Infection, Cellulitis, or Pneumonia can kill if it is not addressed early. The tragedy is that symptoms of ineftion are masked by the pain and anxiety medications. Also, the medications result in weird symptoms that are inadvertently confused with overdose, strokes, heart attacks and blood cloths. Herein lies holy grail of hospital medicine practice. Inpatient care specialists who are not seized with the business of managing infections do so to the detriment of good treatment outcomes, increased length of stay, and probably increased cost of care. The secret of good hospitalist practice lies in relentless focus on getting the right diagnosis fast, and setting patients on the right treatment path fast. This is absolutely true for drug addicted patients with infection. The Farasi Drug Addiction & Infection virtual community will examine these issues to help different members of the community including patients, their family members, friends, coworkers, and healthcare providers provide adequate care their loved ones dealing with addiction and infection. As you browse through, expect discussions on the hot button issues relating to drug addiction, drug overdose, infections, healthcare autonomy, healthcare consumerism, and hospitalist medicine. Welcome to the community, and enjoy the read!
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A powerful network for a stronger community; who is Farasi Drug Addiction& Infection Community?
Drug addiction is everyone's problem. Heroin addiction affects an entire spectrum of humanity; parents, children, students, bosses, employees, professionals, traders, retirees, etc. Cocaine knows no bounds either; doctors, lawyers, engineers, nurses, are not spared either. Percocet, Hydrocodone, Oxycodone, Morphine, Xanax, Ativan, can be addictive to anyone, including grandfathers, grandmothers, mothers, fathers, sons, brothers, daughters and sisters. And yet some of our loved ones depend(rightly or wrongly) on these prescription medications to have some decent quality of life. Yes, all of us would do better if we managed without these addictive medications. And yes, often times we feel that our loved ones would be better served if they were weaned off these medications. Not surprisingly, when our loved ones eventually end up in the hospital, we see it through the lenses of drug addiction whether recreational or prescribed, and we(family members and healthcare providers) often see this admission as an opportunity to reed the patients of this addiction. The question is, should we be focussing on curing this addiction, and, should we restrict access to benzodiazepines, opiates or narcotics to these patients in effort to shape their future behaviour? If we are liberal in making these medications available to these patients as we do to every other patient in the hospital, are we enabling substance abuse as healthcare providers. Should we make only tylenol and motrin available for pain for patients with Opiate abuse when they get admitted to the hospital, and if we make narcotics, benzodiazepines available to them, at what point is it safe to introduce these medications? And, what should we do when they ask for a benzodiazepine prescription at discharge? These and many other critical questions ought to be honestly answered by everyone in the patient's circle. There are no perfect, right or wrong answers, but there is what we do and what we don't do. Of course the choices we make have consequences. It will become apparent what choices are usually made, and how these choices could be improved on. As you browse through Farasi Drug Addiction & Infection virtual community, be sure to acknowledge some contradictions as to how these complex choices are made. Of course, every choice is patient and provider specific, although some providers and patients have blanket approaches which may serve them reasonably well most but not all the time.
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The Impact Of Autonomy and Consumerism in HealthCare as it pertains to Drug Addiction & Infection
The future of our healthcare lies in our hands. As the authors of the Impact of Autonomy and Consumerism in Healthcare so laboriously illustrate, healthcare decisions and choices will increasingly be made by consumers themselves, for better or for worse. Simple decisions like whether to take another pain pill when pain is not going away, or taking another anxiety pill when consumers feel more anxious, can turn from a simple process to a catastrophic outcome as some consumers keep popping the pills when they should stop to ask why they need more pills. For family members, when should they realise something is wrong with their loved ones? When should they seek expert opinion, and when can they manage at home? Important questions that will be answered as you read along!
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Healthcare Providers, what does Drug Addiction and Infection have to do with your role as an Emergency Department provider, nurse practitioner, physician assistant, hospitalist or critical care provider?
As healthcare providers, we are the last line of defence against preventable deaths linked to infection in the setting of prescription and recreational narcotic and benzodiazepine use. A high Index of suspicion, and deliberately looking out for this deadly combination will help save lives. A comprehensive assessment that entails a good medical history(which is often hard to cobble together as most of these patients will be encephalopathic if not comatose, and there maybe no reliable witnesses as to how things evolved at home- yes there will be the witnesses who "know" the patient's history of narcotic or benzodiazepine use, or the witnesses who find the patients unconscious and call 911), a quick but thorough examination that starts with the toes going up(believe me, a lot is hidden in the feet and legs, and is often not discovered if the legs are the last to be examined, if at all they are examined- we tend to focus on the breathing, and level of consciousness, which are of critical importance for resuscitation purposes, however, trying to figure out what happened requires a thorough and deliberate exploration of all the body parts, especially the often forgotten, noncritical ones like legs), laboratory and imaging studies with a focussed intend to sniff out infection as quickly as possible-most of the time infection is staring right in our faces, yet we ignore it. That elevated white count is not caused by dehydration. It is more likely that infection is causing dehydration, and is being manifested by leukocytosis. The so called atelectasis or poor opening up of lungs reported by the radiologist is just what the radiologist says if there is no other evidence to suggest infection. Often times, a normal chest x ray is not helpful when patients are dehydrated. So, the astute clinician has to put the subtle pieces together. For instance, patients may have a low grade fever because they are taking products with tylenol. So a temperature of 99.9F may no constitute a fever in the conventional setting, but should raise concern in the setting of narcotic use. If the radiologist suggests that patient has pulmonary edema, they may not be aware that the patient is dehydrated, therefore both statements cannot be true. It is more likely that the patient aspirated hence aspiration pneumonitis, or the patient has had pneumonia building up with symptoms being masked by narcotics or patients just ignoring the symptoms, hoping they are temporary and will go away on their own. Hypotension has to be taken seriously. Unless patients are bleeding, that hypotension is likely related to infection. If patients need vasopressors, they more than likely will need broad spectrum antibiotics as well. If they need antibiotics, better make sure they are adequately covered. Like a famed investment guru, Warren Buffet would say, "It is better to be approximately right than to be precisely wrong". You have to assume a worst case scenario pending more information. That means that you have to be as broad as necessary in antibiotic choice until you get information, in form of positive cultures or patient recovery, that enables you to deescalate antibiotics appropriately. Of course, the pharmacy will call to narrow antibiotics quickly. In general, antibiotics can be quickly deescalated if a focussed approach was taken from the time of admission. A lot of clinicians want to be precise and right. However, sometimes it is better to feign ignorance and enable broad antibiotic coverage, pending more information. Clinicians sometimes say they are 100% sure of what is going on at the time of admission. Suffice to say this is seldom the case. As we explore the intricacies of narcotic, benzodiazepine, cocaine linked infections, learning from the experiences of others will be helpful. You will hear stories and experiences of different providers in the Farasi Drug and Infection Community. Stay tuned!
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