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> I love Doc Holiday's humor.
--> Well then... Maybe YOU can explain it to my wifey, 'cause she doesn't! She's just huffed out to go shopping or something, simply because I made some comments about the level of intelligence aimed at by certain TV programmes...
> That being said we see patients routinely through age 21 and will cover adults when the main ER is full
--> I am an "adult" EP myself, but I tried to restrict my reply to the point of view of the children's ED we run. It's one side of the same department with the adult side being bigger, but law keeps them separate physically. Still, the senior rank covers both.
> IV fluids - I give enough for them to be able to walk, talk, and leave my ER
--> Not aware of this. You have fluids which sober people up? Is it fluid deficiency which affects balance and speech?
As we never discharge them before they can eat and drink and walk and are sober, then we are able to give them ORAL drinks to rehydrate. And when that point takes some time to get to, with their parents sort of forced to stay with them, THAT is the "lesson" we teach, via the parents' inconvenience, which we then hope they make their children "appreciate". Again, our patients are younger than yours sometimes.
A colleague did an evidence appraisal for this a few years back FOR ADULTS and found only 3 relevant papers (Troups et al, 1992, Gershmann, 1991 & Li et al, 1999 - all from USA), none of which were brilliant evidence, but all found NO evidence of benefit of IV fluids. Last I know, there were NO useful papers published on this for child patients.
> No banana bag needed for extreme majority of kids
--> Banana bag? Que?
What is it?
(I have a maybe guess - I THINK I know what you mean - but rather find out for sure, so please tell)
> and I want them to have a headache in the morning so they think twice before doing this again.
--> Alcohol is a part of our culture here, so the hang-over is a "badge". It won't scare people off. It's like the burn from a good chilli - you sweat a bit, but you'll do it again!
Also goes a bit against the grain to inflict suffering of the medical sort to teach a lesson. Like suturing self-harm lacerations without local anaesthetic... We prefer to inflict "inconvenience and education and parental incentive". But I recognise the feeling ;-)
> urine tox to look for coingestions...
--> Not sure whether you got the impression we do them, but we don't. Sorry if I misled. Indeed, if I wanted to do it, I'd have to find a lab to do it through!
Not being "anti"; just want to find out... Why do you do it? Which substance is it you are looking for that has a specific antidote you'd give based on the urine findings without a clinical picture mandating it via signs & symptoms? After all, while intoxicated or otherwise symptomatic, we'll treat what we see that needs treating (e.g. vomit, airway, seizure); not certain this will be helped by knowing the chemical causing it - do please tell. I'm serious - if my ED and lab cannot even do this test, what have we been missing out on all these years?
Ideal if there is some evidence to go with it for me...
> remember that just because someone is drunk does not preclude a serious head injury
--> Indeed. Agree 1000%.
Actually, we make a point of spending time with our trainees to actually PROVE to them that THEY ALREADY KNOW that evidence of intoxication makes a serious head injury MORE likely than otherwise, not only not precluded. We take time to actually DO THE MATHS and make them say it out loud.
We encourage them to write it on paper and stick it on the ceiling above their bed...
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