EtOH ToxicitySeptember 15, 2014

Primary Assessment

• Form a general impression.– Do they need C-Spine?– AVPU– A&O assessment

• What’s your name (from ID)?• Who is the president of the United States?• What state (location) are you in right now?• What is the year?

– Determine any life threats.– Do not be tricked! Conscious and breathing patient does

not necessarily mean a stable patient

Primary Assessment

• Airway and breathing– Are they talking to you? If so they have open

airway – but be prepared for suction– Do not hesitate to give oxygen!

• Circulation– Assess the patient’s circulatory status and pulse

and skin condition• Cap refill!

Primary Assessment

• Transport decision– Based on:• Vitals (Are they stable?)• LOC • Trauma (Any obvious deformities i.e. evisceration at a

tailgate two years ago)• Recommendation from fire safety

History Taking

• Investigate the chief complaint.– If your patient is responsive, at this point begin to

take a SAMPLE history.– If your patient is not responsive, obtain this

history from bystanders (i.e. friends, family, ID, medical bracelets!)• If unresponsive use ALS, and gather as much

information as possible for them (with at least one set of vitals)

History Taking

• SAMPLE history– Use SAMPLE as a tool of deductive reasoning to determine

underlying conditions

• Also, ask the following questions:– What is the substance involved (may not just be alcohol)?– How long ago did the patient use this substance?– How much of the substance did the patient consume?

• Consider how much patient weighs when taking into consideration substance abuse– A 200 lb frat bro who is only responsive to pain only after 2 beers

has something else going on with him

Secondary Assessment

• Physical examinations– Look for DCAPBTLS

• Vital signs– Look for alterations in the LOC, HR, R, BP, and skin

signs.

Reassessment

• Reassess ABCs.• Repeat the assessment of vital signs:– Every 15 minutes for a stable patient– Every 5 minutes for unstable patient

• Average LAFD response time is 6 minutes. You should have at least one set of vitals and a SAMPLE done by the time they get there (unless unresponsive)!

Possible Underlying Conditions

• Trauma

• Shock

• Electrolyte disturbances

• Cardiac disorders

• Alcoholic Ketoacidosis

General Tips

• Control the scene– Be confident (use the cheat sheet!) and don’t let

the patient/patient’s friends bully you– You are here because they need help, and as a

result you need to get certain information/vitals from them

– Be friendly, yet stern