5-150
Follow-up Actions
Evacuation/Consultation Criteria: Personnel who attempt suicide usually require evacuation. Consult
mental health professionals at any point in your evaluation of a service member who presents with indications
of increased risk for dangerous behavior or acts.
Mental Health: Substance Abuse
MAJ Michael Doyle, MC, USAIntroduction: Opiates, including codeine and oxycodone preparations and benzodiazepines are the two
categories of drugs for which life-threatening intoxication can be reversed. Barbiturate overdose is frequently
fatal. Alcohol can infrequently be fatal. Alcohol, benzodiazepines, and barbiturates (found in medications like
Fiorinal and Fioricet used in the treatment of migraine headaches) can cause life-threatening withdrawal after
chronic use. Opiate withdrawal is uncomfortable, but not life threatening.
Subjective, Objective, Assessment and Plan
Differential Diagnosis: Intoxicated patients should always be monitored for overt and covert overdose.
At times, severe withdrawal states may present as delirium or as psychosis (primarily in alcohol withdrawal,
and this is rare). It is not uncommon to see signs of withdrawal from a substance (alcohol, illicit or prescribed
drugs) in service-members early in the course of an operation, once access to the substance is denied.
Table 5-9
Intoxication T P R BP Motor Eyes Complaints Mental Status
↓ ↓ ↓↓ ↓ slowed miotic pupils euphoria when slurred speech,
Opiates pinpoint in high, N/V and "nodding off",
overdose constipation later unresponsive in OD
Rx: Naloxone, 0.8 mg/70 kg slowly administered by IV.
NC NC ↓ ↓ ataxia NC to talkative irritabilaty, emotional
(-) uncoordination sluggish, sedation with dis-inhibition,
nystagmus ↑dose confusion and stupor;
Benzo- in severe OD, coma
diazepine and death
Rx: 1. Intoxication: Flumazenil, 0.2 mg IV over 15 seconds; repeated after 45 secs and again each
subsequent minute until sedation reversed/relieved to a maximum of 1.0 mg total dose given. 2.
Overdose: Flumazenil, 0.2 mg IV over 30 seconds. 0.3 mg given after 30 secs if no response and up
to 0.5 mg each subsequent 30 second interval to a cumulative dose of 3.0 mg.
NC NC ↓↓ ↓ ataxia NC to talkative, slow dis-inhibition,
uncoordination sluggish, speech and confusion, inattention,
Barbiturates nystagmus thinking slurred speech; in OD,
coma and death
Rx: Very little beyond supportive measures of ventilation, hydration and nutrition support can be provided.
Withdrawal
↑ ↑↑ ↑ ↑↑ fine tremor, ↓visual N/V, fatigue, agitated, irritable,
Alcohol restless, acuity anxiety, insomnia hallucinations and
12-72 hours delusions, illusions,
after last drink confusion, seizures
Rx: Treat those with autonomic evidence of withdrawal (↑ pulse, temp, BP or visible tremors) with Valium
5-10 mg po 3-4 times a day on the first day of withdrawal. Do not give a dose once the patient begins to
feel groggy or sleepy. Continue to assess and monitor vitals and treat on days 2 and 3 if T, P, BP
are still elevated.