# ETOH trauma patient with language barrier



## randomfire (Sep 10, 2013)

Ambulance got called for an assault, arrived on scene to find one of our usual drunks lying on the ground with a small pool of blood by his head. He has a laceration right above his eyebrow with a fair amount of swelling. It is not actively bleeding much anymore. A bystander mentioned he saw him getting kicked on the ground. He is alert to verbal and one of the engine company crew that speaks spanish talked to him and said he said he was hit with a hammer. She said he was answering questions appropriately but none of us know because it was all in drunken spanish. Eyes are PEARL but sluggish. We board and collar him, checking his back as we roll him onto the board. There are no other obvious signs of trauma. We take vitals in the back of the ambulance and begin transporting to a trauma center. BP 130/80, HR 104, O2 92% RA. We give him 4L via NC and O2 improves to 97%. We consult with the hospital and tell them the GCS is 14 (opens eyes in response to voice, interpreter said he was coherent, able to obey commands)We do a rapid trauma assessment (we probably should have done this before boarding him) and note tenderness in the lower abdomen, left femur and left humerus. No deformities to the leg, but there is a knot sticking out of his arm (I felt it gently, he definitely winced and it felt a little hard but I really have no idea what a broken bone there would feel like). 

The problem is, at the beginning of the ride he was kept saying something when we asked his name but due to etoh and language barrier I have no idea if he was conversing normally or if it was incoherent or what and would raise his arm sluggishly, but it was hard to assess while he was boarded. By the time we got to the hospital (10 mins) he was only opening eyes to painful stimuli (2) and wasn't talking anymore or making any noise (1), but again we couldn't tell if that was due to etoh or him also being frustrated with the language barrier and being boarded. He wasn't obeying commands and he also wasn't posturing at all (1). The trauma center was annoyed because I guess they gave it a lower priority and then had to call someone to intubate him because they decided it was more serious than we had called in (vital signs they took were still stable).

So I know we :censored::censored::censored::censored:ed up. What should we do differently in the future? How would you assess a GCS on a guy like that? It seemed wrong to call in and tell them his GCS dropped from a 14 to a 4 (basically dead, right?) in 5 minutes when all his vitals were normal and it was probably a combination of etoh and language problems.


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## Achilles (Sep 11, 2013)

Did the FF who spoke Spanish ride with you? If not I would have had them. Was it a priority 1, 2, or 3? Why would it be wrong to call in if the Pts status changed. That's something the hospital should know.


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## RESQGUY (Sep 11, 2013)

You took him to a trauma center right ? Your scene time was short. You just need experience man, you did fine. Lean on side side of caution when dealing with these type of pt's. Don't get burnt on the "drunks".


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## NomadicMedic (Sep 11, 2013)

I've become a lot less puckered when a patient who's consumed ETOH becomes "unresponsive" if the vital signs remain stable. I watch capnography, EKG and blood pressure. 

Aside from realerting the ED about the status change, you did nothing wrong. I mean, what else would you do?


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