Judgment call: When do you decide to intubate an unconscious drunk person?

[Veneficus]

Just in case this post was not sarcastic.

Unresponsive drunk person, only to painful stimulation, lets not for get to check the blood sugar and possible some Narcan. You never know...

If you are going for a coma cocktail, I sincerely hope you have some thiamine with you.

and if you carry and use it maybe some Romazicon.

Absolutely not.

Romazicon, while a reversal agent is not benign. Infact it has so much adverse potential, it is just better to ventilate until the benzo wears off unless there is some mitigating factor for doing that.

Maybe a little anti-nausea...whichever you carry

Zofran, maybe.

Promethazine will likely just depress her further, so I don't think I could advocate that either.

Sometime in pharm I was once taught that all medications are poisons. If you are going to poison somebody, it needs to be done with some care, with a benefit over risk, and not anymore than required to achieve that.

Otherwise you turn a simple drunk person into a ATP depleted causing neuro deficits and cardiac issues, degrade the GCS further likely facilitating a vent and its complications, wipe out the ability to sedate/stop a seizure with the lesser of two medications, (then your option is a barbiturate like thiopental) which is definately buying an ICU stay, not only causing more harm to the patient, but driving up the economic waste too.

AND don't forget to get mommy and/or daddy's home phone number so the ED can call someone sober to come and pick them up (the best time to call is 0300) and they can drive how many hours to come and take them home. Plus that way mommy and daddy can see what their hard earned insurance is really paying for.

Yea, just make sure she is still a minor first or you will be in breach of patient confidentiality and you and your organization will be paying for her education through medical school.

I might also mention that punishing or torturing patients is generally considered worthy of revocation of priviledges to practice.

All of that, for a drunk college kid, a scenario played out all over the world everyday? Way too much effort and headache.

 

[thegreypilgrim]

Based just on the info you presented - that is, if I were reasonably sure she hadn't vomited and that she didn't take anything aside from alcohol - intubation wouldn't be on my mind at all.

In fact I'd be more on board with transporting to a sobering center if I were permitted to as opposed to the ED.

 

[slb862]

Working both EMS and Emergency Department, in a college town, I have taken care of and seen this type of pt. many a time while working. Maybe I misunderstood, I was taught any time you have an unresponsive, (unknown), ETOH involved...you check the blood sugar, narcan -(cuz you never know what could have been slipped in that drink or what they may have taken), IV - fluids for the dehydration, HM - cuz you are not going to take any chances other "drugs" could be on board, and transport to a local hospital.
As for the Romazicon, I should have clarified it is given in the ED, (ordered by the doctor). OOPS!
And for calling the parents, you bet I do, when working in the ED. Whether they are under the age of 18 or any age for that matter (and in college or not), yes we do call a parent if need be. (Most times that is the only number they can rattle off). Do I give them pt. information, or why they are in the ED, or any personal medical information? No I don't, I am calling to make sure the Intoxicated pt. has a sober ride and someone sober to keep an eye on them for the rest of the night. (maybe I was a little sacrastic.)
Most of your intoxicated college students have spent the night drinking with their friends, guess what, either they don't answer the phone or they themselves are to intoxicated to drive and pick them up. -_-

 

[EMSLaw]

All of that, for a drunk college kid, a scenario played out all over the world everyday? Way too much effort and headache.

This.

The circumstances vary here, too. If the patient has had so much to drink that they have fallen into a coma, then intubation might be indicated. But if this is the kind of call where the patient has drunk themself into a pretty bad stupor, but has no airway compromise, and just needs to be observed, then you have a totally different situation.

Of course, where you need to really start worrying is if the patient has had any sort of trauma. TBI vs. ETOH is almost impossible to determine in the field, and I've heard very persuasive arguments that such a patient should go to a trauma center. Who will probably say, "Why did you bring us a drunk?" Which is probably what the case will be, but better that than a patient with a subarachnoid hemorrhage dying in observation at your local general hospital.

 

[clibb]

Just as we have all been taught. Keep it very basic.

Is the airway patent? If she starts vomiting in an altered state or is unable to control her tongue thus impeding the airway, she needs to be intubated.

If she can maintain her own airway, set her up in a fowlers position, give her some oxygen as needed, and take her to the ER.

You wouldn't put her in the recovery position in case she all the sudden starts vomiting? Just wondering.

 

[MrBrown]

Brown would be barely inclined to take her to the hospital, recovery position, words with the cops to clear out all the drunks, sober room-mate to leave her with and thats that.

 

[Flight-LP]

You wouldn't put her in the recovery position in case she all the sudden starts vomiting? Just wondering.

If she can maintain her own airway (as described before), then no. Should she start to vomit, then we reassess the situation (i.e. an ongoing assessment).