1. Alcohol Assessment and Management of the Intoxicated Patient

2. Aims of the session Recognise the prevalence of alcohol and its significance in the pre hospital setting Identify the recommended daily units of alcohol for men and women Understand the physiological effects of alcohol Discuss the assessment of an intoxicated patient Discuss the safe management and disposition of an intoxicated patient

3. Epidemiology Alcohol – related disease accounts for 1 in 8 NHS bed days (around 2 million) Up to 35% of all accident and emergency attendances and ambulance costs are alcohol related Between 12 midnight and 5am, 70% of attendances are alcohol related

4. Hospitals 40% of all attendees at A&E have a raised blood alcohol level 43% are problem drinkers 20% of patients admitted to hospital for other reasons are drinking at hazardous level 14% are intoxicated

5. Alcohol and Accidental Injury Alcohol has been shown to be a Factor in or associated with: 20 – 30% of all accidents 39% of deaths in fires 37% of pedestrians killed on the road had drunk over the legal limit for driving 15% of drownings

6. 14 units 21 units a week 1 unit = 1 measure spirits = ½ pint 4% larger = ½ glass wine What are the limits?

7. CAGE Questionnaire Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticising your drinking? Ever felt bad or Guilty about your drinking? Ever had an Eye opener to steady nerves in the morning? CAGECAGE Yes to > 2 is quite good at detecting alcohol abuse and dependence

8. Alcohol Withdrawal Stage I:Tremulousness: 6-36 hours Stage II:Hallucinations: 12-48 hours Stage III: Seizures: 6-48 hours Stage IV: Delirium tremens: 3-5 days Not necessarily sequential

9. Withdrawal Differential Diagnosis? Acute cocaine/amphetamine intoxication Heat stroke Sepsis Thyrotoicosis Hypoglycaemia Intracranial process: trauma/CVA Encephalitis/encephalopathy

10. Activity

11. What to assess - History Environment Medical history Social history

12. What to asses – Baseline Obs Pulse –Rate, rhythm, depth, quality…. Respiratory Rate –Equality, depth, adequacy…. Blood Pressure –Bilateral? GCS –AS IS with notes in comments box Oxygen saturation

13. What to assess – Focussed Examination ECG BM Temperature Peak Flow FAST Hands on examination – expose and examine! CAGE questions

14. REPETITION of observations is the only way to show a TREND

15. Blood Pressure 120/95 15 minutes before 15 minutes later… 170/100 (may be normal for patient) 90/60 (radial pulse present) DEAD

16. Any Questions?

18. Cheers!

19. References NICE Alcohol use disorders (2006) Alcohol- can the NHS afford it? Royal College of Physicians (2006) www.drinkaware.co.uk www.Alcohollearningcentre.org.uk Institute Alcohol Studies www.ias.org.ukwww.ias.org.uk