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> We are looking into establishing a policy for ETOH intoxication in our pediatric ED
--> We have strict rules against emergency physicians being intoxicated at work. I mean, EM is one of the specialties least suitable for working while intoxicated (while it might be OK for radiologists and probably ideal for psychiatrists and I certainly can't see how anyone can cope with a career as a neurosurgeon without completely avoiding sobriety).
You mean the patients...
> We frequently have multiple college students presenting with varying degrees of intoxication
--> We restrict registration in our children's ED to children. For us that is to age UNDER 16, unless the child is still in high school and WANTS to be seen as a child (the default is they don't ask is adult treatment).
Still, we occasionally do get an intoxicated teenager. This is uncommon. I cannot recall the last time we had more than one in at the same time.
> Does anyone have any policies regarding intoxicated patients, specifically regarding testing, monitoring, treatment, and discharge criteria?
--> A few.
- DON'T test ethanol levels... Unless you are really curious, in which case - STILL DON'T. It's a test result we cannot use. We teach our trainees to assume there is no alcohol in the system and rule out and action positively all other general causes for whatever neurology symptoms we are seeing. Antiemetics for vomiting; analgesia for pain; CT/imaging for abnormal neurology and head injuries as per non-intoxicated; check glucose; advanced airway management; etc... As none of these, if they are indicated, would be left out whether the level is zero or X times the limit, there is no point in checking what the level is
- Just because alcoholic drinks taste nice does not mean that one should ignore it if one thinks the child is drinking to the point the child KNEW/THOUGHT would be harmful, i.e. self-harm with alcohol is self-harm. Any child INTENDING to be intoxicated gets followed up. We aim to make a nuisance of ourselves to these kids (and threir parents)
- For any child unable to explain EXACTLY and articulate to perfection that he does not want parents involved (which is 100% of them), we'll call their parents to rush to the ED. We'll aim to initiate investigation of "which adult MADE this child drink" until a lot of effort is made to successfully convince us that this was beyond something the responsible adult could control. Social workers will get involved, etc. We are going to cause major paperwork - we'll really take the joy out of any drinking experience
- A parent who PERMITS intoxication is CAUSING harm to the child with intent
- An institution which allows this - WE call the police
- We NEVER discharge a child who presents with intoxication from the ED. We ALWAYS admit. Even if child sobers up completely within an hour of arriving. Child will have to be seen by a senior doctor the next morning! No child will be allowed to finish recovery at home with a "responsible adult", even if it really looks safe to do so. They will always sober up fully, THEN eat a proper meal after that AND be seen to be keeping it down for a couple of hours, or no discharge.
Other than these (unless I forgot one or two) we don't have specific treatment/procedure for alcohol.
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