Alcohol-Related Issues in an Emergency

Assessing Alcohol-Intoxicated Patients

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Alcohol can be a major complication in emergency or rescue situations. Sometimes the intoxication is the problem (such as with alcohol poisoning).

More often, typical illnesses and injuries are complicated by alcohol. As a first responder, you'll have to make adjustments to assessment and treatment when the person is intoxicated.

This article looks at issues of consent, special considerations for assessing the patient, and what to think about when treating them.

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Intoxication and Consent

In all cases, people with medical emergencies must give consent for a rescuer to help. They need to understand:

  • Why medical treatment is necessary
  • The consequences of refusing treatment
  • The possible side effects of treatments they receive

Intoxication affects the way consent works in first aid and emergency medical situations. An impaired person may not be able to understand what's happening or what you tell them.

It's often assumed that if intoxicated patients were sober and reasonable, they would accept help. The more intoxicated they are, the more it applies. This form of permission is called implied consent.

Challenges of Intoxication

The basics of first aid don't change simply because a patient is intoxicated. In fact, they're even more important when your patient is impaired.

When evaluating an intoxicated person, be aware of and check for:

  • Aspiration: Alcohol depresses the gag reflex so the person may inhale their vomit (aspiration). This leads to an airway emergency.
  • Respiratory depression: Deep intoxication may lead to slow, shallow breathing. Intoxication may cause a severe reaction to lack of oxygen from shortness of breath.
  • Vertigo: Alcohol-induced vertigo can lead to nausea and vomiting.
  • Decreased blood pressure: Alcohol dilates the blood vessels and decreases blood pressure. That blocks the body's ability to compensate for bleeding and shock and can lead to hypothermia.

You'll also need to take into consideration the effects of altered consciousness and the possible effects of long-term drinking.

Respiratory Depression

Substances other than alcohol can cause even deeper respiratory depression. Opiates, such as heroin, commonly cause complete respiratory arrest (cessation of breathing). Respiratory depression from benzodiazepines, such as valium, gets worse when combined with alcohol.

Altered Consciousness

Alcohol causes several changes in a person's level of consciousness. Slurred speech, unstable gait, and confusion are the most common.

Those symptoms are similar to signs of various brain injuries and illnesses, including: 

These conditions may be confused with or masked by intoxication.

Effects of Long-Term Drinking

Myriad physical changes can result from moderate to severe lifetime drinking. Chronic alcohol abuse damages organs including the liver, esophagus, brain, and heart.

Chronic alcohol abusers also tend to use other damaging substances—like tobacco—that have their own health consequences.

Intoxicated people are prone to falls, which can cause head injuries. That's of particular concern given that alcohol causes brain atrophy (shrinking) and weakened blood vessels.

  • 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 susceptible to rupture and bleeding.

The combination of these factors leads to an increased risk of intracranial hemorrhage.

Recap

Intoxication complicates consent. Implied consent may have to be assumed.

Assess the person for aspiration, respiratory depression, vertigo, and low blood pressure. Be aware of how altered consciousness and the effects of long-term drinking may affect the situation.

Dealing With Intoxicated Patients

It may be tempting to dismiss an intoxicated person's complaints because of their inebriation. They smell of alcohol and may have undesirable traits, like incontinence, that make them unpleasant to treat.

However, dismissing them can mean overlooking very real medical problems. There's no excuse for a poor assessment.

  • Always assume signs and symptoms are from the most severe medical condition possible.
  • Rule out causes systematically, working toward less serious conditions.
  • Remember that intoxication may be the least of someone's problems.
  • Understand how the intoxication may make outcomes worse.

Even if the person is difficult to deal with, treat their needs regardless of their drinking habits and behavior.

Summary

Alcohol can complicate emergency situations. Implied consent may be necessary, depending on the degree of intoxication. Evaluate them as usual with an eye out for aspiration, respiratory depression, vertigo, and low blood pressure.

Don't assume altered consciousness is only from intoxication. Remember that long-term drinking may have serious health consequences that may complicate the situation.

It's never acceptable to dismiss complaints or skip steps in an assessment because someone is impaired. Start with the assumption that their symptoms are from the most severe condition possible and go from there.

A Word From Verywell

Emergency situations are stressful and can be chaotic and confusing. Impairment from alcohol or drug use can compound all of that.

If you find yourself trying to assess and care for an intoxicated person, rely on your training and keep in mind the ways their impairment can complicate or mask an acute medical issue. Your help and compassion can make all the difference in the outcome.

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