Commentary on Medical Management of Trauma (Injury) in the
Presence of Alcohol Use and Abuse, by Enoch Gordis, M.D., former
Director, National
Institute on Alcohol Abuse and Alcoholism (NIAAA).
In managing traumatic injury, it is essential to obtain accurate
information on patient alcohol use and to refer alcohol abusers for
appropriate treatment.
Although extensive evaluation of alcohol abuse, especially in busier
emergency rooms, may not always be feasible, at a minimum, screening of
blood alcohol levels must be done routinely. Doing so provides a quick
picture of alcohol as a factor in managing the trauma without
compromising emergency room functioning. It also reduces risk for errors
that can result from basing diagnoses solely on external signs, such as
inebriated behavior or the smell of alcoholic beverages on a patient's
breath, rather than basing diagnoses on appropriate medical evaluation.
Bias against treating an inebriated patient who is uncooperative and
disruptive may lead to quick disposition of that case in order to free
up time for more "deserving" patients. Or, stupor in a patient
smelling of alcoholic beverages might be assumed to result only from
heavy drinking. In either instance, appropriate medical evaluation could
uncover head injuries, such as subdural or epidural hematoma, or other
problems that often coexist with alcoholism, such as hypoglycemia, use
of drugs other than alcohol, bacterial infections, or meningitis.
Alcoholics who incur trauma but, because of well developed tolerance,
show no evidence of intoxication, present a special dilemma due to a
variety of unexpected alcohol-related complications that may arise
during trauma management. For example, depending on the recency of their
drinking, many alcoholics vary in their response to therapeutic drugs,
including anesthetics, a critical factor if an operation is required. An
alcoholic patient also may enter withdrawal, further complicating
management of the traumatic event.
Once patients have been stabilized, practitioners have another
responsibility that is all too often ignored--referring alcohol abusers
for appropriate alcohol treatment. Doing so is just as medically
necessary as managing the traumatic event. In general, patients who
should be referred include reasonably coherent persons with a high
concentration of alcohol or other drugs of abuse in their body fluids;
persons who are inebriated; persons who are in withdrawal; or persons in
whom there is evidence of repeated trauma. Treatment needs will vary
among victims of alcohol-related trauma, ranging from minimal
intervention for episodic abuse to more intensive treatment for alcohol
dependency.
Through referral, emergency medical personnel can help alcohol
abusers and dependent patients reduce their risk for life-threatening
health consequences, including future episodes of alcohol-related
injury. Referral is especially critical for the many young victims of
alcohol-related trauma for whom early intervention has a great payoff in
terms of years of potential life saved.
Click here for a full and
complete description of how the Narconon Arrowhead alcohol addiction
rehabilitation program works!
|
