1. Craisin
    Offline

    Craisin New Member

    Joined:
    Jun 20, 2016
    Messages:
    9
    Likes Received:
    5
    Location:
    London, U.K.

    U.K. Medical Emergencies

    Discussion in 'Research' started by Craisin, Oct 3, 2016.

    Had a few questions:

    1. At a house what would an off-duty doctor, Cardiothoracic Surgeon if it makes a difference, do differently in an emergency situation (unconscious person)?

    2.What information might they relay to 999 that a layman wouldn’t?

    3. Is there a way that this doctor might realise from their symptoms that the patient has had a sleeping pill overdose, without there being any pill bottles or suicide note around?

    4. Is there a medical term, for 'sleeping pill overdose'? Possibly more discreet.

    Thanks for any help!
     
  2. Shadowfax
    Offline

    Shadowfax Contributing Member Contributor

    Joined:
    Aug 27, 2014
    Messages:
    2,505
    Likes Received:
    1,339
    1/ Nothing a doctor can do that a layperson couldn't - but he should be able to do the basics - Airway, Breathing, Circulation - which many a layperson wouldn't know; and you'd hope he'd be able to find a pulse (My WIP has a layperson who fails to find the pulse in the neck, 'cos she's just copying what she's seen on TV!). But a specialist surgeon wouldn't be as good at first aid as a GP.

    2/ Nothing...but you'd expect them to be more organised about it...white male, mid-forties, unconscious but breathing. Pulse slow and steady, breathing regular. Temperature feels a little low. Colour good (I'm thinking of lips, in particular, which might become cyanose if there's a circulatory problem and insufficient oxygen in the blood)

    3/ I doubt that a specialist surgeon would suspect a cause for the unconsciousness. A GP might, especially if he knew the patient - or a member of a psychiatric crisis team probably would.

    4/ a/ A google search of the NHS website found under poisoning...

    Benzodiazepines
    Benzodiazepines are a type of tranquiliser often used on a short-term basis to treat anxiety and sleeping problems (insomnia).

    Specific signs of poisoning with benzodiazepines include:

    • co-ordination and speech difficulties
    • uncontrolled movement of the eyes (nystagmus)
    • shallow breathing
    • drowsiness
    So, no symptoms that would be visible when unconscious!

    Another search found...
    Statistically speaking, a sleeping pill overdose is among the most common ways used by women to attempt or to commit suicide. Sleeping pills act by slowing down the body functions, by relaxing the muscles, and chemically lulling a person to sleep. In theory, a sleeping pill overdose would pretty much shut down the entire body, including the nervous system, respiratory system, and the cardiovascular systems --- all of which would eventually lead to death. A sleeping pill overdose, thanks to the tranquilizing and anesthetic qualities of those medications, can kill a person without pain or agony, which is also the reason why it is very common in suicide cases --- one of which is the death of Marilyn Monroe. However, as police investigators and those who actually survived a suicide attempt can attest, a sleeping pill overdose does not always work.

    The fact is, most of the sleeping pills that are potent enough to be used as a means to commit suicide are no longer being prescribed by doctors. Some relatively high dosage pills might still be available in hospitals but these are only used for anesthetic purposed during major surgery. Sleeping pills that are still sold in the market have milder formulas and are no longer as potentially lethal as the sleep-inducing medications available some years back. In other words, the current generation of pills are now chemically and purposefully designed to be safer. One of the main goals is to make sleeping pills less potent and make sleeping pill overdose lose its ?appeal? as a painless means of committing suicide. However, that doesn't mean that there won't be significant damage to the body or mind, as those factors are still present despite the lower risks of modern pills.

    One more factor to consider would be the specifics involved in the overdose. Some people might have a tolerance for the components of the sleeping pills, thus increasing the chances of survival. Other factors including blood chemistry and the possibility of intervention during the attempted suicide can reduce the probabilities of death. In many cases, alcohol was used supposedly to speed up the effects of the pills. since a sleeping pill overdose does requires time to fully work and deliver its fatal effects.

    Modern sleeping pill overdose situations can still cause considerable damage since present-day drugs almost always produces an effect on the central nervous system. Normal doses only pose very minimal risks but side-effects can still be expected after using large quantities of the drug. The most serious side effect would be the complete shutdown of the neural pathways and receptors that control some of the body's systems. Someone who survives a sleeping pill overdose might find himself completely paralyzed, with little or no control over his bodily functions --- left only to live life as a ?vegetable.?

    Sleeping pill overdose is also a very significant issue in the realm of psychology. Most people would assume that a person who chooses to end life via a sleeping pill overdose has a very serious psychological problem. In most cases, physical stress or a mental illness can be associated to suicides. Mentally-ill individuals who survived their own suicide attempt using sleeping pills are in danger of suffering memory loss, which can occur due to the lack of oxygen in the brain. Other suicide survivors have exhibited paranoid delusional tendencies or were found to have psychological disorders prior to the suicide attempt.
     
    Shbooblie and Craisin like this.
  3. Craisin
    Offline

    Craisin New Member

    Joined:
    Jun 20, 2016
    Messages:
    9
    Likes Received:
    5
    Location:
    London, U.K.
    That's great! Thanks for your help, Shadowfax.

    There will be a relative around to tell the Dr how the unconscious person was acting before they passed out.

    Was just thinking there might be some mad way of detecting the overdose, sort of like the smell of pear drops with Diabetes. Anyway, this is awesome. Thanks.
     
  4. Sifunkle
    Offline

    Sifunkle Dis Member

    Joined:
    Aug 4, 2014
    Messages:
    481
    Likes Received:
    570
    Nystagmus might well be, if the eyes are open or they gently lift the eyelids to look. That's something that can continue into anaesthesia when benzodiazepines are used. It looks like tiny (usually) movements of the eyeballs, in an obvious pattern, which is usually a quick jerk in one direction (fast phase) then a slower turn back to the starting point (slow phase). That most commonly occurs on a horizontal/lateral plane: I believe that applies to benzodiazepines (although other problems can cause vertical nystagmus).

    Benzodiazepines also cause muscle relaxation. Obviously an unconscious person seems pretty relaxed, but there's still underlying tone to plenty of muscles, and benzodiazepines reduce that: that's one specific reason they're used in anaesthetics; some operations are easier when there's less muscle tone (or it can counteract muscle rigidity caused by other anaesthetic drugs) --> this is something an observant surgeon might suspect once s/he gets hands on the patient (probably not with heaps of confidence though -- it might just be one barely-seen puzzle piece in the overall image).

    I don't think there are any '100%' signs of a sleeping pill overdose. I'd imagine that questions around the possibility of suicide would be productive, and looking for a pill box or bottle or whatever would be an obvious avenue to pursue (although you've said there's nothing around, and there could be an easy explanation for that).

    As far as how the character acts before they passed out -- (grain of salt: I'm not familiar with benzos in such high dose) as Shadowfax alluded to, they're not particularly strong, and especially if they've been taken orally, the onset of action could be delayed/gradual/patchy. If the patient is riled up, the adrenaline, etc can override the effects of the drug for a while, and even once it's starting to take effect, you can see 'breakthrough' (quickly returning to consciousness) with a strong enough stimulus. But a higher dose is probably going to make that all quicker and harder to fight. I suppose the pattern would be like 'a sleepiness that's hard to fight' (fairly intuitive for sleeping tablets...:bigoops:) plus teetering around/floppiness from the muscle relaxation aspect.

    One other thing with benzodiazepines is that they can disinhibit behaviour (much like alcohol, I suppose). So if the character was full of barely contained rage, that might no longer be contained! You sometimes hear of unexpected aggression. Or perhaps they'd say things they'd usually keep under wraps.

    Just to be clear (although I imagine Google's probably done that already), benzodiazepines are drugs like diazepam (Valium) and alprazolam (Xanax). These days, I think Xanax is probably the most likely for suicide attempts. In my country, it's recently had the same sort of controls applied as opiates get, so has to be kept in a locked safe and each fraction of a tablet dispensed must be tallied up in a record book.

    Good luck!
     
  5. Tenderiser
    Offline

    Tenderiser Not a man Contest Administrator Supporter Contributor

    Joined:
    Aug 12, 2015
    Messages:
    4,288
    Likes Received:
    5,158
    Location:
    London, UK
    I'm not sure we get Valium and Xanax here... I think I might have heard of someone taking Valium, but certainly not Xanax.

    In the UK we're more likely to refer to drugs by their drug name rather than brand name; moreso than in the US (and perhaps elsewhere). I've heard of diazepam much more often than Valium.
     

Share This Page