Alcohol in an Emergency

Assessing Alcohol Intoxicated Patients

woman passed out on a bench with beer
Drunk or unconscious? It's not always easy to tell. Matt Cardy / Getty Images

Assessing a medical condition or complaint is difficult under the best circumstances. In the prehospital environment, where most rescues take place, there are often loud sounds and issues with bystanders to make the assessment of medical complaints that much harder. To make matters worse, alcohol often plays a role in rescue situations.

Most often, when rescuers are faced with an intoxicated patient, they are not responding to an emergency directly related to the alcohol, such as alcohol poisoning.

Instead, rescuers are responding to patients of typical illnesses and injuries - complicated by alcohol or drugs. An acutely intoxicated patient requires a diligent assessment.

Alcohol may mask certain medical conditions and alcohol intoxication appears similar to many life-threatening conditions. Chronic alcohol consumption causes damage to the body that leaves alcohol abusers more susceptible to certain medical conditions. Regardless whether a patient is simply intoxicated for a single incident or is a chronic alcohol abuser, certain adjustments for assessment and treatment will have to be made.

Consent and Alcohol or Drug Intoxication

Intoxication affects the way consent works in first aid and emergency medical situations. In all cases (intoxicated or not), patients of a medical emergency must give permission for a rescuer to help. It's required for the patient to understand the necessity of medical treatment before agreeing to any help, as well as understanding the consequences of refusing treatment.

patients must also know the possible side effects of any treatment they receive.

That's a lot of information. It's particularly difficult for a patient impaired by alcohol or other substances. Because of the complexity of thought required, it is often assumed for intoxicated patients (the more intoxicated, the more it applies) that if they were sober and reasonable, they would accept help in their condition.

We call this form of permission implied consent.

Alcohol and the ABC's

The ABC's of first aid do not change simply because a patient is intoxicated. In fact, the ABC's become much more important for an impaired patient. Alcohol is a central nervous system depressant and can depress the gag reflex, causing an airway emergency. Alcohol also causes vertigo in some people, which leads to nausea and vomiting. Vomiting and a depressed gag or cough reflex will lead to aspiration of emesis (vomit) into the airway.

Deep alcohol intoxication may lead to depressed respiratory effort, causing the patient to breath slowly and shallowly. Besides alcohol, there are several other substances which cause even deeper respiratory depression. Opiates, such as heroin, commonly cause complete respiratory arrest (cessation of breathing). Benzodiazepines, such as valium, also cause respiratory depression and become more potent when combined with alcohol.

Alcohol causes dilation of the blood vessels, which decreases blood pressure and blocks the body's ability to compensate for bleeding and shock.

Vessel dilation (vasodilation) lets blood rush to the skin and flood the surface of the body, where it is cooled - potentially leading to hypothermia.

Alcohol causes several changes in a person's level of consciousness. Slurred speech, unstable gait, and confusion are the most common. Anyone who's seen an intoxicated person knows how intoxication can make a person act and sound. Those reactions are similar to signs of various brain injury and illness. Stroke, closed head injury, and hypoglycemia are common brain-related conditions that result in speech and gait disturbances, which may be confused with alcohol consumption.

Besides the acute effects of alcohol consumption on the neurological function of the brain, there are physical changes that result from moderate to severe lifetime drinking. Of particular concern is brain atrophy ("shrinking" of the brain). Brain atrophy leaves more room inside the cranium for blood to collect during a brain injury. Alcohol weakens the walls of blood vessels and makes them more susceptable to rupture and bleeding. The combination of these factors leads to the increase of intracranial hemmorrhage, and the consumption of alcohol leads to the possibility of falling.

Victims are Never "Just Drunk"

There may be a tendency to dismiss intoxicated victims' complaints because of the indicators that alcohol is present. Severely intoxicated victims will often smell of alcohol and may have undesirable attributes, like incontinence, that make them unpleasant to treat.

With all these effects of alcohol on the body and mind, very real medical problems can be overlooked.

Knowing the consequences, there's no excuse for a poor assessment. Always assume signs and symptoms are from the most severe medical condition possible and then rule out causes in turn, working toward less serious conditions. Often, alcohol intoxication is the least of a victim's problems.

Professionals and lay rescuers alike must take alcohol intoxication into account when assessing victims of illness or injury.

Just the presence of alcohol can make some outcomes worse. An intoxicated victim with shortness of breath may have a more severe reaction to a lack of oxygen.

Chronic alcohol abuse leads to very serious medical problems, damaging organs as diverse as the liver, esophagus, brain, and heart. Not to mention, chronic alcohol abusers tend to use other damaging substances - like tobacco - with their own consequences. Treat victims' needs regardless of their drinking habits.

References:

  • Cardenas, VA, C Studholme, DJ Meyerhoff, E Song, and MV Weiner. "Chronic active heavy drinking and family history of problem drinking modulate regional brain tissue volumes." Psychiatry Res 138(2005): 115-30.
  • National Collaborating Centre for Acute Care. Head injury: triage, assessment, investigation and early management of head injury in infants, children and adults. London (UK): National Institute for Clinical Excellence (NICE) 2003
  • Cherpitel CJ, Ye Y, Bond J, Rehm J, Cremonte M, Neves O, Moskalewicz J, Swiatkiewicz G, and Giesbrecht N. "The effect of alcohol consumption on emergency department services use among injured patients: a cross-national emergency room study." J Stud Alcohol. 67(6)2006: 890-7.
  • Genetta, Thomas, Ben H. Lee, and Augusto Sola. "Low doses of ethanol and hypoxia administered together act synergistically to promote the death of cortical neurons." J Neuroscience Research 2006

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