paramedic911
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Can EMT's make breath test for patient to find alcohol in there blood by using breathalyzer device or other method ? If cannot Is this bad idea ?
alcohol test by EMT
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DesertMedic66
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The only place I know that does this is AMR's mobile Healthcare units. They are not normal units in the slightest and do not respond to emergency calls.
Why would we need to find out the exact number of their BAC in the field?
Why would we need to find out the exact number of their BAC in the field?
Because treatment is 100 times different... -_-
DesertMedic66
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Can't tell if you're being sarcastic..
NomadicMedic
I know a guy who knows a guy.
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My vote is yes.
Angel
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Im with desert, what difference would it make?
ding ding ding!
Ewok Jerky
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because if they are drunk they don't deserve my pain meds even though they were ejected during the rollover.
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I wouldn't mind having a portable breathalyzer. Is it really that much different than using a glucometer as one of your diagnostic tests? Not that it rules anything out, but it could prove at least helpful in some of the "altered secondary to head injury or alcohol" situations. I would never dismiss someone based on a BAC reading or assume all current problems can be attributed to alcohol just because of whatever number it reads, but if you have an altered patient who may or may not have been drinking and they end up blowing .000? Well, that certainly raises my index of suspicion for something more severe causing the issue rather than continuing to wonder if it could be alcohol and something else. Passing along to the hospital that your altered MVA patient with a head lac has a normal BGL and BAC reading as well could certainly get some attention.
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We breathalyze and saliva drug test patients that we transport directly to a mental health crisis stabilization unit. We only carry them on the flycar type vehicle that does these transports.
I will have LE breathalyze patients that I want to take to the local hospital. They refuse to take drunks but will take drunk people with a medical complaint so long as they aren't "really drunk."
I will have LE breathalyze patients that I want to take to the local hospital. They refuse to take drunks but will take drunk people with a medical complaint so long as they aren't "really drunk."
LACoGurneyjockey
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So the ER will refuse the patient if their complaint is altered secondary to etoh? Or if they're "really really drunk" and complaining of abdominal pain and nausea? That doesn't seem legal unless I'm missing something...
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We have a hospital similar to this. If the primary complaint is "intoxication and disorderly" that's really more of a psych/law enforcement need than anything else. One local hospital can't take disorderly psych patients as they don't have security available to do 1:1 sitting. If I follow what Tigger mentioned, our hospital will do the same and treat drunk patients with a medical complaint or severely drunk patients with some kind of airway compromise or complete loss of consciousness. At that point, they fall back into the medical realm rather than custodial supervision law enforcement doesn't want to deal with.
Umm yes? Was that a serious question?
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Yeah. Serious question. It's different in that we have an easy way to treat someone who is hypoglycemic and symptomatic, but otherwise it still gives you a value that helps paint a clearer symptom of what's wrong with the patient.
If you have an unconscious patient who has a BGL of 163 mg/dL, it's relevant in that you have ruled out hypoglycemia as a cause for the change in mentation. If your altered patient from a MVA with a couple beer bottles in his crashed car blows .02 but still exhibits slurred speech and an unsteady gait, your index of suspicion for head injury would likely be increased.
As mentioned, we're not using it to minimize patient's complaints, but simply to gain a clearer picture. You'll note hospitals are interested in running a blood alcohol level as part of their work up. Why shouldn't we do the same if available?
DieselBolus
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It falls squarely into treating the patient and not the number. The presentation is what matters here.
You could have 3 patients of the same weight and age and the same BAC, one singing Ke$ha songs, one throwing up on themselves, and one with the shakes. Would knowing they all had a .08 help you at all?
Let's use your scenario with a .02 bac with slurred speech and unsteady gait. How would you alter your treatment for this patient compared to a .04? or .08?
You could have 3 patients of the same weight and age and the same BAC, one singing Ke$ha songs, one throwing up on themselves, and one with the shakes. Would knowing they all had a .08 help you at all?
Let's use your scenario with a .02 bac with slurred speech and unsteady gait. How would you alter your treatment for this patient compared to a .04? or .08?
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My point isn't that my treatment would change at all for any of these patients. It's simply another piece of information. You're right in that a 0.08 for one person could be equivalent to a 0.16 in someone else. To me, this would be similar in finding BGLs of 90 mg/dL vs. 180 mg/dL. Interesting to note, but not really relevant to my care towards the patient most of the time. My interest in knowing it would be the extremes.
Someone with a 0.45 who is incoherent and intermittently conscious gives you more information to work off of than if you didn't have it. As I said, no treatment would change nor would it rule out more occult causes of the presentation, but it would add to the differentials. It would be more useful to have this value for this same intermittently conscious patient who has a BAC of 0.00. That is a clinically significant finding ruling out a likely cause of the condition. Airway management and whatever other treatment methodologies you go down don't change, but it gives you and the hospital a big step up in knowing the common cause that's already ruled out.
We're not scared of other findings in medicine, so I'm not certain why EMS has built up this huge mythos surrounding BAC usage. We're meant to be professionals who don't discriminate, so why should testing a clinically relevant lab value easily and cheaply used in the field be taboo to us? I didn't expect to be the only one arguing this side, but I'm very interested in hearing the other viewpoints and appreciate the discussion!
Someone with a 0.45 who is incoherent and intermittently conscious gives you more information to work off of than if you didn't have it. As I said, no treatment would change nor would it rule out more occult causes of the presentation, but it would add to the differentials. It would be more useful to have this value for this same intermittently conscious patient who has a BAC of 0.00. That is a clinically significant finding ruling out a likely cause of the condition. Airway management and whatever other treatment methodologies you go down don't change, but it gives you and the hospital a big step up in knowing the common cause that's already ruled out.
We're not scared of other findings in medicine, so I'm not certain why EMS has built up this huge mythos surrounding BAC usage. We're meant to be professionals who don't discriminate, so why should testing a clinically relevant lab value easily and cheaply used in the field be taboo to us? I didn't expect to be the only one arguing this side, but I'm very interested in hearing the other viewpoints and appreciate the discussion!
DesertMedic66
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Healthy people sometimes have a hard enough time doing the breath test. I have no idea at all how you would convince an altered patient to blow into the straw as hard as possible for a decent amount of time.
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Well, I'm envisioning a perfect world of hypotheticals where I obtain a BAC from some sort of magical device. Think glucometer or iSTAT. That's how it works in my head for the sake of argument even though I know it doesn't exist. You're right though. The ones I would care most about the value likely couldn't follow commands. Perhaps something more sensitive that needed less air exhaled?
COmedic17
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As some are saying, having a BAC would help you recognize wether the behavior is ETOH or a possible head injury, as someone said...but if someone has a high enough BAC you can most def smell it. And if someone was in a car accident and is incoherent, does the fact they are ETOH rule out a head injury? No. All it means is its a drunk person with a possible head injury as opposed to a sober person with a possible head injury. Both might have a head injury. Both should be treated as they have a possible head injury.
If there's a potential mechanism of injury, treat it as such. If you pull up to a alley and a patient is rolling around in his urine and vomit with colt 45 cans everywhere, then you really don't need a breathilizer.
If there's a potential mechanism of injury, treat it as such. If you pull up to a alley and a patient is rolling around in his urine and vomit with colt 45 cans everywhere, then you really don't need a breathilizer.
Or you could just use your brain instead of wasting time with a cheap breathalyzer. If they don't smell of booze, and the scene is not indicitive of them sipping the apple juice, more than likely they are not drunk enough to be unconcious.
Edit @COmedic17 beat me too it. What she said.