Alcohol and the emergency service patient.

Holt, S; Stewart, I C; Dixon, Julia; Elton, R. A.; Taylor, T.; Little, Keith M.

doi:10.1136/bmj.281.6241.638

Cited by 197 publications

(53 citation statements)

References 14 publications

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“…Although there appears to be no clear relationship between per capita alcohol consumption and the incidence of fatal accidents per se, there is no doubt that alcohol intoxication is a major cause of trauma [ 1,2,5]. Fractures are 10-20 times more common in the alcoholics than in the normal population, which means for example that a simple trauma questionnaire can successfully be used as a tool for the diagnosis of alcohol abuse and to determine the patterns of excessive consumption [5-81. Relatively little information has been available to Correspondence: Onni Niemela MD, Department of Clinical Chemistry, University of Oulu, Finland. 182 date, however, on the clinical characteristics of cerebral trauma in alcoholics, although improved methods have become available for assessing brain functions after head injury [9-151.…”

Section: Introductionmentioning

confidence: 99%

Cerebral trauma and alcohol abuse

Rönty

Ahonen

Tolonen

et al. 1993

Eur J Clin Investigation

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Abstract. We report results of clinical examinations, computed tomography, quantitative electroencephalography (QEEG), and cerebral blood flow measurements performed on a series of 56 consecutive brain injury patients including 15 alcohol abusers and 41 non-alcoholic subjects. Greater volumes of intracranial haemorrhage were noted in the alcoholics for a similar severity of injury and local brain atrophy became more pronounced in them during a follow-up of 1 year. After this time, the third ventricle width, distance between frontal horns, the sum of lateral ventricle dimensions and cortical sulci were all markedly larger in the alcoholics. The QEEG results also indicated a weaker improvement in the alcoholics. The cerebral blood flow at the site of the injury was initially slow in the alcoholics when compared to the contralateral region of the other hemisphere, although these differences disappeared during the follow-up. Permanent occupational disability was also found to be associated with pretraumatic alcohol abuse.The findings indicate that ethanol abuse is not only commonly associated with cerebral trauma but is also a risk factor for a more severe brain damage following the injury.

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Section: Introductionmentioning

confidence: 99%

Cerebral trauma and alcohol abuse

Rönty

Ahonen

Tolonen

et al. 1993

Eur J Clin Investigation

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“…Alcohol intoxication is a frequent diagnosis seen in the Emergency Department (ED) and may often be associated with other life-threatening illnesses that are masked by alterations in behavior or level of consciousness [1,2]. The intoxicated patient may present with sudden loss of consciousness, seizure, abdominal pain, chest pain, suspicion for the abuse of other drugs, or potential injuries following a motor vehicle accident.…”

Section: Introductionmentioning

confidence: 99%

The clinical significance of variations in ethanol toxicokinetics

2007

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Introduction: Many variables affect the interpretation of an isolated ethanol level in an acutely intoxicated patient. This review demonstrates the significant variability in metabolism and elimination of ethanol, how it can differ between individuals, and the clinical importance of these variables.Discussion: Isolated ethanol values in a clinical scenario are only a snapshot of a dynamic process. The individual pharmacokinetic differences of people make it extremely difficult to estimate ethanol elimination rates or calculate previous ethanol concentrations at the time of an accident because of medical-legal reasons. Not only are the techniques used in measuring ethanol concentrations in bodily fluids (blood, serum, breath, and urine) not equivalent, but also the units used to report ethanol concentrations are often misinterpreted. Acute and chronic tolerance and social adaptive changes make interpreting this isolated ethanol level extremely difficult. The purpose of this review is to enable the clinician to appropriately interpret ethanol concentrations. Conclusion:The clinical evaluation of a patient's inebriation is always more reliable than an isolated ethanol level for determining disposition. Only an estimation of a current serum ethanol level can be made if the blood draw was performed hours earlier. This review is clinically important because it shows the clinically significant variability in metabolism and elimination of ethanol and how it can differ between individuals. It will also describe different ways to measure ethanol concentrations and how to compare them. Finally, the interpretation of isolated ethanol levels will be discussed.

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“…Cette porte nouvellement ouverte de l'hôpital fut attrayante pour toute souffrance et on constate alors un flux important de la population vers les services des urgences. Vers la fin des années 50 la littérature signale un polymorphisme de patients qui se dirigent vers les services des urgences « admissions inappropriées » soit par leur profil médical considéré comme non urgent [7] ou par leur profil social [8,9]. Au début des années 70, des études signalant la charge accrue de travail et l'encombrement des urgences émergent alors comme un sujet important pour la recherche.…”

Section: Concept D'urgence : Genese Et Evolution Dans Le Tempsunclassified