Wednesday, November 5, 2008

Alcohol....The Good & the Bad....

Well, just finished up a string of night shifts and things just don't get better. It amazes me how many ED visits are linked to alcohol. One night shift (a Saturday), alcohol contributed to 25% of the visits. Take for example the 30-some-year-old who fell outside of his new house after loosing his footing. He didn't have any serious (as defined by life-threatening) injuries but required a plastic surgeon to repair the multiple complex and complicated lacerations to his face and ear (and that cost him a lot, especially if his insurance didn't cover some of the expenses).

Or how about the other 20-some-year-old who was at a party at a friend's house (and I suspected "mouthed off to someone else") and ended up getting punched in the head. He fell and suffered a brief period of unconsciousness. Fortunately, both patients were awake and pleasantly drunk as opposed to the many nasty drunks who present with possible injuries and needed to be sedated for their safety, the safety of the staff and my safety. The last thing I want is getting into a nasty altercation with a nasty drunk in the ED.

Alcohol obviously is not limited to older folks. The same evening I had two separate teenagers come in by way of ambulance. One 16 and the other 19 (both under the legal age of drinking). Both were drunk as hell, one vomiting. When the parents arrived, they were mortified. If you have any children, you can understand getting a call from the ED saying that your child was here and not knowing what to think.

The 16 year old female had a blood alcohol of around 350. To give you some perspective the legal driving limit in most states is 0.08 or 80%, and she was over 4 times the legal limit. Fortunately, she was not driving! As a parent, I pray that I never have to deal with a call from the ED, let alone for a drunk kid. Fortunately, both kids left after giving them some IV fluids, IV medication to avoid them from vomiting again, and a period of observation.

I've had staff members and parents say, "Let them suffer, why make them feel better, teach them a lesson!" That's part of emergency medicine, treating everyone the same, and maintaining an unbiased approach to all patients. Unfortunately many physicians in the field suffer from burnout and end up becoming very jaded in their approach and treatment of patients. The day I become jaded will be the day I leave emergency medicine.

I have been a physician for approximately 20 years and despite much frustration for caring for patients in the ED, I have no intention of leaving quite yet...although the night shifts do take their toll and you often feel sorry for yourself and your life style since many in America have "9-5" jobs, weekends, and holidays off...

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