I’ve been having a number of jabs on Facebook (2 or 3 comments in 2 or more places) about the all too common intoxicated patient.
There are those in our ranks who believe they have the ability to determine when a person is “just drunk” implying that no assessment is required.
We need to make a clear delineation on our terminology before moving forward. First, notice in this post title that I do not use the term “drunk” but instead intoxication.
Drunk is the extreme form of intoxication. Drunk refers to one affected by alcohol to the extent of losing control of one’s faculties or behavior.
While certainly not an emergency, a person who meets the definition of drunk is in no way, shape or form able to assist in an assessment for other mimics to intoxication such as stroke, hypoglycemia and sepsis, just to name a few.
A drunk person is likely to be semi-conscious or unconscious. These folks are horrible at maintaining a clear airway and can get into trouble fast if not properly taken care of. That may not always mean a hospital, however. More on that in a moment.
How many times have you been called out by PD for the “alcohol poisoning” only to find someone alert, ambulatory and smelling of alcoholic beverages? Is this person drunk? Only after a complete assessment will we be able to determine if their level of intoxication meets the definition of drunk.
Here’s a quick tip: Your local protocols probably don’t have a section for this. There’s an altered mental status section, but no, “He doesn’t need to go to jail but we can’t let him drive home, so take him to the hospital” section.
PD is adorable on these calls, often telling a patient they can either go to jail or to the hospital. I often cal their bluff, when appropriate, and tell the patient they can still refuse transport (After my assessment finds them able to do so under local policy).
Intoxication is, technically, a poisoning. All levels of alcohol ingestion constitute alcohol poisoning if you want to get down to the nitty gritty. The key is going to be determining to what extent the intoxication is impacting your patient’s ability to make sound decisions regarding their care. Plain and simple.
My local policy states that, among other elements, the patient does not appear to be under the influence of drugs or alcohol in order to be able to refuse care. That’s a big gray area. They may be intoxicated, but able to comprehend my questions, weigh their options and have a plan for decreasing the level of intoxication in the near future.
These folks should have a sober adult with them and not operate a motor vehicle, but they seldom need an ambulance ride to an ED. Think about it. What will the treatments be? Fluids? If they are able to sit in triage long enough they could drink more water than any IV could run in in the same amount of time.
Now, before you go running off to your next drunk call and leave someone lying in the street because of something I wrote, let me ask you this:
How do you know they are merely intoxicated and not drunk?
Remember the definition? Losing control of one’s faculties or behavior. We all have that one friend that overindulges and becomes an idiot, but are they drunk or intoxicated?
Stop looking for zebras. Sometimes drunk is just drunk but you won’t know until you assess.
Unconscious people are unable to make sound decisions. Semi-conscious people are the same. Ambulatory people who have been drinking may still be able to understand their situation. Only after a complete assessment will you know for sure.