Drunk guy w/ possible meds, Tube or not?

[Just Plain Ruff]

Dwayne, I know a couple of medics that have done just that, intubated a drunk for being a jerk. one even said "I showed him who was boss"

I then proceeded to demand the medical necessity of the intubation and when they couldn't produce a medically necessary reason for intubating the patient, I took it to the medical director. That ended their job at our shop.

As for anti-emetics, Zofran seems to have proven itself with it's benign properties and it can really be used on anyone but didn'twe think the same with Inapsine or phenergen?

I do like zofran but I always am saying in the back of my head, will this drug eventually be proven harmful just like inapsine was.

I don't think I would have intubated this guy unless he kept vomiting and he kept passing out at the same time but with a 30 minute transport time who knows. I wasn't there.

Kudos on coming here and asking questions but I think a better place for you to go to is your medical director and discuss this with him. He knows your area (hopefully) and your patient population so I suspect that he would have better insight than we do.

Take care

Ruff

[HERBIE1]

He's a drunk who threw up; I'd be inclined to clean him up and drop him off at home or he might end up at the cop shop

Well, in the old days, there used to be drunk tanks. Essentially the cops would pick up someone for public intoxication and have them sleep it off in a jail cell for the night. Eventually the slip and fall lawyers capitalized on this and found one of those drunks who happened to be a diabetic, and the process was ended with a big lotto payout.

Also, the new designer drugs like Excstasy and Ketamine complicated matters, and often times, those who appeared to be simple drunks are actually overdoses. Game changer.

Now it's all about liability and nobody wants to be sued.

[Riblett]

I think you handled this patient very well. Although I probably would have considered an anti-emetic, I can understand your line of thinking with not wanting to stop his body from throwing up a potential poison. But considering you did not have a strong suspicion of an oral medication or illicit drug OD, his continual vomiting is likely due to being really intoxicated. Besides if the ER doctor decides that his stomach contents really do need to be evacuated, an NG tube will do the job regardless. His continuous vomiting is a threat to his airway, and remember that is your priority. Break out the suction and do the best you can. Roll him on his side and keep his airway clear.

Remember that as a newer generation paramedic you should not be relying on intubation as much as in the past. Expect some differences in opinion with the old-school folk. There is much less emphasis on field intubations, because in so many cases the benefits fail to outweigh the risk. Less than 8, intubate is a thing of the past. If you can manage an airway without a tube, do it. If this guy is a simple drunk, control his airway and let him sober up in the ER. He'll go home in a few hours. But if you tube him, you are potentially buying him several days in the hospital maybe even the ICU. He will require sedation (which brings in a whole new set of risks.)He may have problems surrounding extubation and be exposed to dangerous hospital acquired infections, including a potentially fatal ventilator acquired pneumonia. I am not saying not to intubate, because sometimes it is necessary. But remember that it is one of many tools in airway management and every tool has an appropriate usage.

[kohlerrf]

I'm with "Dwayne". Its a tough call to tube or not. Dwayne had a really great point though, LLR and puking into towels is key. Here is your argument to any ER staff that questions your airway control. "I am alone out there and I need to stop a potential airway problem from occurring rather than correct one that I did not otherwise prevent".

I'm with "Dwayne". I think you did a great job in a tough situation. Its a tough call to tube or not. Dwayne had a really great point though, LLR and puking into towels is key. The effectiveness of simple BLS is so often underestimated. Should you decide to tube and get an argument to form any of ER staff that questions your airway control simply remind them "I am alone out there and I need to stop a potential airway problem from occurring rather than correct one that I did not otherwise prevent".