Diagnosis
The purpose of blood alcohol measurement in the average patient who is presumed to be intoxicated.
What is rule out ethanol intoxication (Strayer et al, 2023).
What is the way out.
Goals of treatment in patients presenting with presumed alcohol intoxication (will accept 2/3).
What are identify dangerous medical conditions, provide a safe area for recovery, and address underlying alcohol use disorder (Strayer et al, 2023).
The E in ABCDE that should be done to every presumed intoxicated patient.
Distracting patients are dangerous because.
They take attention away from the other patients.
The test of choice in a patient who you have determined is definitely ethanol intoxicated without any unexpected or complicating features.
What is none (Strayer et al, 2023; EM Fundamentals, pg. 23).
This is given first to a patient who is disruptive.
One attempt to verbally de-escalate.
Two things given to a patient who is hypoglycemic, obtunded, and nutritionally deficient.
What are D50 and 100-250 mg thiamine IM or IVP (Rosen's pg. 1857).
The goals of the neurological exam in the presumed intoxicated patient.
What is examine for gross strength and sensation (EM Fundamentals, pg. 22).
Median LOS for an intoxicated patient.
What is about 6 hours (Klein et al, 2017).
Two readily reversible diagnoses that should be in the differential for all altered patients.
A practice in administration of sedatives that increases the risk of respiratory depression.
What is mixing classes (Internal Document).
One thing that routine IV hydration for ethanol intoxication does and one that it does not do.
What is prolongs LOS and what is does not increase ethanol clearance.
Four features of a psychiatric history which are important to elicit in the intoxicated patient both before and after they sober.
What are suicidal ideation, homicidal ideation, auditory hallucinations, and visual hallucinations (Internal Document).
The percentage of patients presenting with alcohol intoxication who require critical care.
What is 1-4% (Strayer et al, 2023).
What is hypoventilation.
The endpoint to which medical therapy in a patient presenting with an intoxication mimic causing bradypnea and miosis should be titrated.
Restoration of normal respirations (Rosen's pg. 1960).
Key historical feature, usually elicited from EMS if a patient cannot speak for themselves, that should frighten you if it is absent.
Clear history of substance use.
Blood ethanol level beyond which death may occur secondary to respiratory failure.
What is 400 mg/dL (Mayo Clinic Labs).
The "tips on the vowels" (mine has 19 items - 10 and mnemonic completion for $).
What are Alcohol/Acidosis/Arrhythmia, Electrolytes/Encephalopathy/Endocrine, Infection, Oxygen/Overdose, Uremia/Urinary retention, Trauma/Tumor/TTP/Temp, Psych, Seizure/Stroke/Syncope (MGH White Book 2020 pg. 183; Rosen's pg. 1830).
The medication of choice (with a dose!) for sedation of a person who is uncontrollably violent and the location where they should be triaged.
What is ketamine 5 mg/kg IM and where is the resuscitation bay (Strayer et al, 2023).
What is 6 hours post-ingestion for cocaine and heroin and 8 hours for meth.
All items comprising the GCS.
What are eyes open spontaneously, to verbal stimuli, to pain, or not at all.
What is orientation, confusion, inappropriate words, incomprehensible sounds, and none.
What is obeys commands, localizes pain, withdraws from pain, flexes to pain, extends to pain, and none.
The highest survived blood ethanol level.
What is 1,500 mg/dL (O'Neill et al, 1984).