Drunk guy w/ possible meds, Tube or not?

[HERBIE1]

If the person's LOC was enough for them to hold their airway- what was their Glasgow score?- but 6 shots of booze with a normal person would not generally cause them to be so drunk they would lose their airway- BUT couple that with anything else they may have done- drugs, other booze, I would keep an eye on them. First, many times people LIE about their ETOH consumption, about possible drug use, etc. I also do not know if the Adderal and booze has a synergistic effect. Maybe they have an underlying problem detoxifying that alcohol- ie liver problems. Maybe they are running on no sleep, maybe they have no food in their stomach.

Point is, when the person is vomiting is NOT the time to realize they cannot hold their airway. Keep an eye on the patient, but no intubation yet.

[speedygodzilla]

Sounds like you did fine. I see no reason for RSI or intubation with a drunk that is maintaining their airway. The antimetic would of been a good thing to add to your treatment. All and all sounds like you did great. Thanks for bringing it up and asking for our opinions.

I give fluid bolus to pretty much all of my drunk patients. At least if their c/c calls for an IV. I have had nurses get rude and ask how I would like 8 glasses of water when I ask for a beer. I respond that is not my concern. Not like I am a bartender lol

Please feel free to post more and welcome to the city.

[DwayneEMTP]

A couple of things...

First, if I knew of a medic that intubated a drunk pt for punishment I would take every step possible to burn him/her down. There is no room in professional medicine for that type of idiotic, unprofessional behavior. I'd burn them down not only for being unprofessional and unkind, but for being ignorant enough to consider intubation a benign procedure. To risk permanent throat injury/pneumonia to a pt to 'teach them' for being drunk is not only unprofessional but morally bankrupt.

Second, Doc says he should have had anti-emetics (in a perfect world) so that seals it for me. But I'll tell you one of the many things that I'm coming to like a lot about you, is that in many medics minds, vomit = antiemetic, who can fault me for that? But instead of taking the obvious, easy way out, you chose instead to say, "What is best for my pt? Not just now, but throughout his recovery?" And that is friggin' awesome! The upside? Thinking like that will always get you respect from silly medics like me, as well as many that are much better than myself. The down side? Sometimes when you think through your problems, instead of simply following protocol, you're going to screw the pooch. You will make some mistakes, but I truly believe that a well educated, pt focused process will almost always keep them from being giant mistakes.

A well balanced approach is what seems to work for me. I very much respect my protocols, but question whether they are right, or all that is needed for each pt. That seems to keep my wee wee out of the wringer while providing the very best care that I can at the same time.

It's good to have you here.

Dwayne

[Richard B the EMT]

A question for our Docs and nurses. Do nurses not train in intubation and/or nasal intubation? I actually had one nurse point to my nasal tube and ask the Doc, "What do you want us to do with...whatever that its?!" He said, "It's a patent tube, just leave it where it is." I'm not poking fun at nurses, I've just wondered since then if they were stating it in that way because they didn't recognize it, or being sarcastic because they thought that it was a poor choice.

Just commenting that in 37 years in "da biz", I've been trained in how to do a nasal intubation, but have never seen anyone, BLS or ALS, use one field side. It might also have to do with the fact that where I work, the nearest ER is usually no more than 15 to 20 minutes away (I love New York City).

[Kiwiology]

How the heck did you plan on intubating this guy? Please tell me they didn't give you suxamethonium and etomidate / ketamine / midazolam or the like.

[tcripp]

I, too, am a fairly new medic working in a rural area with transports up to as much as 1.5 hours if we have to drive. However, we are usually alone in the transport. So, intubation for us might be the better course of action to avoid aspiration.

Were you the 'lone medic' on this run? If not, how many other hands did you have?

Now, as to an antiemetic...that would have been the first thing after the IV I would have given. No reason to tempt the aspiration fates if I'm not going to take ownership of that airway. Besides, my practicum in my final semester had me with more than one ETOH patient. I learned the hard way on that one...if you catch my drift.

[ambodriver]

With the information provided I don't think I would have intubated. If he is spitting then he should a good gag reflex. Let 'em puke but be ready to suction if you need to I guess. With such a long transport an anti-emetic would have been nice....for the medic assigned to clean and the pt.'s airway.

I hate dealing with drunks, especially when they are puking. What a waste of time.

[Lifetaker]

Wow. I never thought I would get such a response. Thank you to everyone who responded. I have many questions and will probably be posting many more questions. All of your input was very helpful. If anyone has any questions for me please ask. Or any more input.

So I work for a company with some paramedics that RSI just about anyone. They say, If they can't drink a glass of water, they need to be intubated. Well, half the Pt's we transport can't drink a glass of water and we don't intubate them. Anyway thank you all again for your input. Glad to be a part of the City and keep on truckin.

[chbare]

What a bunch of morons IMHO. Better have them intubate every patient with a suspected hip fracture or RSI every kid with a suspected hot appy because these people will not be drinking any glasses of water.

Spend a day with me in the ICU caring for patients with ARDS and aspiration pneumonias following intubation. I've actually spent more than a couple of days liberating otherwise healthy people from the ventilator who received "precautionary" intubation in the field because they were drunk and...gasp...lethargic.

I don't mean to offend, but some people just love to find nails in every situation when we give them a hammer.

Take care,

chbare.

Edited October 12, 2010 by chbare

[Kiwiology]

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