December 28, 2018
Preparing for the Holidays: Parties and Alcohol Poisoning
The holidays are here. It’s party time!
But for EMTs, it’s not so hunky-dory. The holiday season means one thing – lots and lots of party calls.
Why? Usually, it’s due to acute intoxication; AKA “binge drinking”.
In addition to the actual danger of too much alcohol, binge drinking leads to:
- Auto crashes
To prepare for the season, it is critical for EMTs to review the proper response to intoxicated victims.
What constitutes “binge drinking”?
Women – usually 4 drinks within about 2 hours.
Men – about 5 drinks within about 2 hours.
What Happens to the Alcohol Poisoned Body:
- Blood cells become saturated with an excess of ethanol
- Cardiac function is impaired
- Brain and central nervous system are sedated by the ethanol, leading to:
- Sedation, lack of coordination and slurred speech
- If GABA neurotransmitters are paralyzed by ethanol, nerve cells shut down and breathing ceases, leading to death.
- Liver is slowed down as ethanol is broken down by liver
- Kidneys, lungs and skin may be damaged
- Alcoholic Ketoacidosis is a condition where insulin is deficient
- Glucose cannot enter cells
- Body needs alternative form of energy
- Body breaks down fat by producing ketones
- Ketone acid made by breakdown overcomes body systems
- Patient exhibits dehydration and labored breathing
Key diagnostic signs:
- Sweet, fruity smelling breath
- Extreme vomiting
- Altered mental status
Treatment – IV fluids (dextrose, sodium bicarbonate and thiamine.)
Recognizing Alcohol Poisoning
- Smell of alcohol on breath/clothing
- Confused and/or dazed presentation (blackouts)
- Lack of coordination and/or stupor
- Seizures and/or gross tremors (shaking)
- Redness and/or enlarged capillaries in the face
- Pale or jaundiced skin
- Secretive nature and noticeable agitation
- Evidence of frequent and unexplainable accidents
- Evidence of poor nutrition and/or hygiene
- History of alcoholism and/or predisposition to drinking
- Elevated body temperature/pulse/blood pressure.
- Nausea and/or bloating
- Vomiting and/or diarrhea
- Abdominal pain/cramping
- Loss of appetite
- Numbness and tingling throughout the body
REMEMBER! Chronic drinkers are experts at hiding their symptoms. Make sure to use a critical eye to assess them.
Even if a patient appears mildly intoxicated, the correct policy is usually to transport them anyway:
- The chemical effects often take time to become apparent
- Patient may be hiding symptoms
Is a breathalyzer a good tool for EMTs?
Not really. It will tell you how much alcohol concentration is in the patient’s blood, but it won’t tell you anything about the physical effects of the alcohol. Since it will not change your course of treatment, it’s best to just rely on the usual assessment tools, such as level of consciousness and other vital signs.
End-tidal Carbon Dioxide Monitoring – since alcohol poisoning can cause respiratory difficulties, monitoring the carbon dioxide output is a great way to check the patient’s respiratory status.
Declaring Incompetence – you can transport the patient against their will if the patient:
- Is not alert or oriented
- Cannot recall events during the alcohol ingestion
- Is unable to quantify how much alcohol was ingested
Airway Protection – patients with alcohol ingestion are likely to vomit and have difficulty breathing, so it is important to open the airway properly and put the patient in a position that is safe for vomiting. Respiratory status should be monitored.
Search for Clues – look for empty containers near the patient that may help determine what the patient ingested.
Check blood sugar level
Gastric Decontamination – only if the patient presents immediately after ingesting the toxic alcohol is gastric decontamination appropriate. Otherwise, it can be expected that the alcohol has been absorbed into the body and cannot be removed through a nasogastric tube.
Be Prepared for violent behavior
Grand Mal Seizures/Gross Tremors – if patient is experiencing any such symptoms, immediate transport to the hospital is indicated.
Remember: Stay safe and enjoy your holidays!