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Sat, 23 Feb 2002 22:13:42 -0500

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Let's remember as well that chemical intoxication is a leading risk factor
for trauma.  Drunks may be neurologically confounding, but they're also
fabulously adept at dying of undiagnosed brain injury.  Ignore them at
your--and their--peril.

Pret Bjorn

 -----Original Message-----
From: Timothy Coats [mailto:t.j.coats@qmul.ac.uk]
Sent: Saturday, February 23, 2002 6:13 AM
To: trauma-list@trauma.org
Subject: Re: ETOH plus headinj.

On 23/2/02 02:17, "canes" <canes@xtra.co.nz> wrote:

Hello all, I'm new to the list, so be nice to me.
I would like to see a discussion on the nursing management of head injured
patients who are also intoxicated with ETOH, and/or "recreational" drugs.
The Glascow Coma Scale is of only limited use with these patients in
accurately assessing rousability and orientation. I have found that doing
honest Q1/2H GCS recordings within the first four hours of these patients'
presentations at the emergency department often gives a GCS result which
dimishes (as blood concentration of ETOH rises.) 
Has anyone got any suggestions re more accurately monitering the patients
condition? Giving rapid IV fluid may be of help to an intoxicated patient,
but may also be contraindicated for the head injury. A CT head is not always
possible or indicated, and conservative treatment is often preferable until
the intoxication has had time to wear off, so to speak. Letting the patient
simply sleep it off would be nice, but is obviously not safe for a
headinjury.
Thanks, Ali. (RCpN)

To avoid missing the intra-cranial bleeds you have to scan a lot of drunks.
Any head injured patient with a decreased level of consciousness needs a
head scan - whether or not you suspect that they may have been drinking.
There is no other way of telling. Wish there was.
Tim.

Mr. T J Coats
Senior Lecturer in Accident, Emergency and Pre-Hospital Care
Bart's and the Royal London School of Medicine

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<TITLE>Re: ETOH plus headinj.</TITLE>

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<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=470210703-24022002></SPAN></FONT><FONT color=#800000 face=Arial 
size=2><SPAN class=470210703-24022002>Let's remember as well that chemical 
intoxication is a leading risk factor for trauma.&nbsp; Drunks may be 
neurologically confounding, but they're also fabulously adept at dying of 
undiagnosed brain injury.&nbsp; Ignore them at your--and 
their--peril.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=470210703-24022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=470210703-24022002>Pret 
Bjorn</SPAN></FONT></DIV>
<DIV><SPAN class=470210703-24022002></SPAN><FONT face=Tahoma><FONT size=2><SPAN 
class=470210703-24022002><FONT color=#800000 
face=Arial>&nbsp;</FONT></SPAN></FONT></FONT></DIV>
<DIV><FONT face=Tahoma><FONT size=2><SPAN 
class=470210703-24022002>&nbsp;</SPAN>-----Original Message-----<BR><B>From:</B> 
Timothy Coats [mailto:t.j.coats@qmul.ac.uk]<BR><B>Sent:</B> Saturday, February 
23, 2002 6:13 AM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> Re: 
ETOH plus headinj.<BR><BR></DIV></FONT>
<BLOCKQUOTE></FONT><FONT face=Verdana>On 23/2/02 02:17, "canes" 
  &lt;canes@xtra.co.nz&gt; wrote:<BR><BR></FONT>
  <BLOCKQUOTE><FONT size=2><FONT face=Arial>Hello all, I'm new to the list, so 
    be nice to me.<BR>I would like to see a discussion on the nursing management 
    of head injured patients who are also intoxicated with ETOH, and/or 
    "recreational" drugs.<BR>The Glascow Coma Scale is of only limited use with 
    these patients in accurately assessing rousability and orientation. I have 
    found that doing honest Q1/2H GCS recordings within the first four hours of 
    these patients' presentations at the emergency department often gives a GCS 
    result which dimishes (as blood concentration of ETOH rises.) <BR>Has anyone 
    got any suggestions re more accurately monitering the patients condition? 
    Giving rapid IV fluid may be of help to an intoxicated patient, but may also 
    be contraindicated for the head injury. A CT head is not always possible or 
    indicated, and conservative treatment is often preferable until the 
    intoxication has had time to wear off, so to speak. Letting the patient 
    simply sleep it off would be nice, but is obviously not safe for a 
    headinjury.<BR>Thanks, Ali. (RCpN)<BR></FONT></FONT><FONT 
    face=Verdana><BR></FONT></BLOCKQUOTE><FONT face=Verdana><BR>To avoid missing 
  the intra-cranial bleeds you have to scan a lot of drunks. Any head injured 
  patient with a decreased level of consciousness needs a head scan &#8211; whether or 
  not you suspect that they may have been drinking. There is no other way of 
  telling. Wish there was.<BR>Tim.<BR>&nbsp;<BR>Mr. T J Coats<BR>Senior Lecturer 
  in Accident, Emergency and Pre-Hospital Care<BR>Bart's and the Royal London 
  School of Medicine<BR></BLOCKQUOTE></FONT></BODY></HTML>

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