Substance use disorders in trauma patients. Diagnosis, treatment, and outcome

The consequences of acute and chronic drug abuse pose significant problems for physicians managing the trauma victim in the resuscitative, perioperative, intensive care, and hospitalization periods. Substance abuse, whether acute or chronic, modifies the physiologic response to injury and to resuscitative and operative measures. Trauma and critical care physicians must have insight into ways to improve the detection, resuscitation, and management of trauma patients with acute substance intoxication or chronic abuse history. The need for prophylaxis of withdrawal syndrome differs with drug type. The major difficulty is proper identification of individuals at risk, which is complicated by patients' unconsciousness, reluctance, or medical inability to give detailed history of substance use. Failure to recognize withdrawal symptoms may both confuse the diagnosis of traumatic injury and be life-threatening. The goal in treating the trauma patient who is also a substance abuser is both to fully assess that person's injuries and achieve physiologic stability and use the hospitalization as an opportunity to educate and counsel the patient to abandon his or her destructive behavior.