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If you've taken a wilderness first aid course you've learned about the human
brain as the "evolutionary onion." The outer regions of the brain, the
cerebrum, are the centers for higher thinking As you move deeper into the core
of the brain to structures like the cerebellum and the brain stem you reach more
primitive areas of the brain which are responsible for basic life functions like
breathing and involuntary muscle control. What this means is that anything which affects the central
nervous system is first seen impacting the higher brain functions (the outer
levels of the onion). This is why checking level of consciousness in your
Patient Assessment System (PAS) is so important. Any change on the AVPU scale (see below) means that the
brain is being affected. A continued decline on the AVPU scale means that deeper
and deeper levels of the brain are being affected.
The human brain, as the body's control center, is the most
sensitive organ in the body. All sorts of changes in the outside environment or
the body's internal chemistry can alter brain function and even cause death. The
mnemonic STOPEAT is use to identify the various factors which can affect the
brain and the central nervous system. STOPEAT is typically used as the set of possible
reasons for someone having a seizure.
Alcohol is a central nervous system depressant. This means that as
more alcohol enters the bloodstream vital body functions will be depressed. At
high levels things like blood pressure, pulse and respiration can decrease.
Expect to see the following changes in vital signs in someone who has had too
much to drink.
Stumble, mumble, grumble, fumble - all common signs that the
highest level functions of the Central Nervous System have been affected. We are
used to watching for these things in cases of Hypothermia and High Altitude
Cerebral Edema. They are also common signs of CNS effects due to alcohol. The
person's gross motor coordination has been impaired leading to falling and
stumbling. The individual may become belligerent and even violent. The person
may be incoherent. While people typically laugh at such "drunken
behavior" it is in fact a clear indication that higher brain function
is impaired. This is someone who has begun to slide down the AVPU scale. If more
alcohol is absorbed into the bloodstream what is viewed as "silly drunken
behavior" can have tragic consequences. The most important thing for you
to realize as a first aider is that the impact of alcohol on the brain is just
as potentially deadly as any of the STOPEAT factors!
When we see these signs and symptoms, what should our reaction as
first aiders be? This is serious! If the person were hypothermic we would
immediately begin active steps to rewarm the person. If the person was at high
altitude, we would start to get them to descend immediately before they became unable
to walk. Should we do anything less aggressive in our treatment of someone who
has a compromised central nervous system caused by alcohol rather than by cold
or high altitude? No way!
Like any first aid situation, you must carefully monitor the
person. The most reliable sign of a serious problem is a decrease in AVPU. This
means that just "letting the person sleep it off" could have disastrous
consequences. If the person is asleep you have no way of knowing if AVPU is
declining. It is possible for someone who is in acute alcohol poisoning to go
into respiratory arrest while they are asleep. If you see a decline in AVPU to
the V level you have a potentially serious situation on your hands. If
someone passes out it means they are U on the AVPU scale. You should know
what this means from first aid. Brain function is severely impaired and death
can be the result. Make sure
this person is constantly monitored and/or transport them to McCosh Health
Center or to the Princeton Medical Center ASAP. Remember, this is potentially just as
serious as a person with increasing ICP. Death is the Anticipated Problem. So
make the right treatment choice early. Better to be cautious and safe (and even
have to deal with a disgruntled friend in the morning) than end up asking
yourself why you didn't act and someone died.
As part of our SOAP Note we have created a general list of
Anticipated Problems and Treatment Plans for someone who is intoxicated. AS you
can see, simple intoxication can lead to serious medical emergencies and death.
One common scenario is vomiting. For a person who is at the top of
the AVPU scale and is fully alert this probably presents little risk. However,
for the person who is sliding down the AVPU scale, vomiting carries a serious
risk of aspirating the vomit and obstructing the airway. Many times people who are
intoxicated are left passed out on a bed by themselves. They vomit (body purging
toxin) and then in their unconscious state aspirate on the vomit and stop
breathing. If left alone death is common.
continues to decline and deeper levels of the brain become affected the more insidious aspects of alcohol
poisoning become evident.
alcohol can affect the respiratory drive and the person may stop breathing.
Hospital care may involve the following advanced treatment techniques that
you as a first aider are not able to provide. Tihs is why is is so critical to
get the person to College Health Center or local hospital:
If you transported him or her to College Health Center or local hospital the
person may be upset or angry about it. You should remember that you acted
for their personal safety. Remind the person that their intoxication placed you
in a position of responsibility as a first aider, one that you could not walk
away from. You took the necessary steps to place them in the safest
environment. You do not deserve for them to angry with you.
If this situation of getting dangerously drunk is a pattern then you
potentially have someone with an alcohol dependence problem. You should seek
advice from an Alcohol Peer Educator or from someone at the College Counseling Center for
what you can do to get this person to get professional help for the problem.
Counting Backwards - when we were trekking in Nepal at over
15,000 feet one of our trip members, Ed, was a neurologist. He told me
that one of the ways for us to tell if someone's higher brain function was
affected was to asked them to count backwards by 9's from 100. If s/he
couldn't do it, it meant that the Central Nervous System was being
affected. This was a common clinical test that he used in his office with
patients who had brain injuries.
The "Sobriety Test" - the police use it and so do
mountaineers on Everest. Asking a person to walk a straight line heel to
toe is a test of muscle coordination and higher brain function. If the
person can't do it, it means that the Central Nervous System was being
affected. On Everest this means immediate treatment with oxygen or descent
before the person is unable to hike down on their own. On the highway it
means that the person is no longer capable of safely operating a vehicle
(either for his or her own safety and for the safety of other drivers or
Drinking & Driving - Think about whether you would want your
younger sister or brother in a car being driven by this person. If you
aren't 100% sure that they do not have any decrease in AVPU then don't let
them drive. It's for their safety and for everyone else's. Your motor coordination can be affected for as many as ten hours after you finished your last drink. So before you get in the car
to drive home the morning after a party, think twice about your ability to drive safely.1
Alcohol, while taken in moderation, is not toxic. However, like
many substances, high levels of alcohol can be toxic to the body and
can lead to death. This is typically
referred to as alcohol poisoning. The level of alcohol in the blood
stream is so high that the affect on the central nervous system is the same as if
you had eaten a poisonous plant that has effects on the Central Nervous System.
Unlike most foods or beverages which must be digested over several hours to be
absorbed, alcohol is absorbed directly into the bloodstream through the tissue
lining of the stomach and the small intestine. When your stomach is empty, alcohol
gets absorbed into the bloodstream in roughly five minutes. Once it's in the bloodstream, it takes
only 90 seconds for the circulatory system to have pumped it throughout the body
organs and the the brain. So alcohol begins to have an effect on the body long
before you are actually "drunk."1
So, what does your body do to get rid of a toxic chemical? Well
just like any toxic substance if you still have some in your stomach, one of
your body's defenses is to throw up to purge the toxin from the system. Vomiting
can be extremely dangerous if the person is going down on the AVPU scale because
of the possibility of aspiration and airway blockage. Once the alcohol is in the
blood stream the only way for the body remove the alcohol is for the alcohol to be processed by the liver. Your liver can only metabolize about one ounce of alcohol per hour.
The amount of alcohol it takes to affect a person's central
nervous system depends on multiple factors including body size and weight,
degree of hydration, amount of food in the stomach (food
in the stomach slows alcohol absorption). To calculate blood alcohol
level check out this
1. Myth: Alcohol improves my
Although you may
think that drinking makes you better in bed, alcohol reduces your
sexual performance. In decreases the ability for men to have an
erection and dries up vaginal secretions in women.
2. Myth: I can drink and
still be in control.
your judgment, which increases the likelihood that you
will do something you'll later regret such as having
unprotected sex, being involved in date rape, damaging
property, or being victimized by others.
3. Myth: Drinking isn't all
One in three 18
to 24 year olds admitted to emergency rooms for
serious injuries are intoxicated. And alcohol is also
associated with homicides, suicides, and
1. Myth: I can sober up
quickly if I have to.
It takes 2-3 hours to eliminate the alcohol
content of two drinks, depending on your weight.
Nothing can speed up this process - not even coffee or
5. Myth: It's ok for me to
drink to keep up with my boyfriend.
alcohol differently. No matter how much he drinks, if
you drink the same amount as your boyfriend, you will
be more intoxicated and more impaired.
6. Myth: There is no point in
postponing drinking until I'm over 21.
that the longer you postpone drinking, the less likely
you are to ever experience alcohol-related
2. Myth: I can manage to
drive well enough after a few drinks.
of all fatal traffic crashes among 18 to 24 year olds
involve alcohol. Your impairment is related to your
blood alcohol concentration (BAC). Depending on your
weight, you can have a BAC of 0.02% after only one
drink, which can slow your reaction time and make it
difficult to concentrate on two things simultaneously.
A BAC of 0.03% can significantly impair your steering.
At 0.04% your vision begins to focus on the center of
the road and you cannot respond as well to street
signs, traffic signals and pedestrians. By 0.05% your
driving will be noticeably erratic, especially to the
8. Myth: I'd be better off if
I learn to "hold my liquor."
If you have to drink increasingly larger amounts of
alcohol to get a "buzz" or get "high," you are
developing tolerance. This increases your
vulnerability to many serious problems, including
9. Myth: I have to drink to
Your peers don't
drink as much as you think they do. A recent survey of
more than 44,000 college students shows that most
students drink little or no alcohol on a weekly
10. Myth: Beer doesn't have
as much alcohol as hard liquor.
bottle of beer has the same amount of alcohol as a
standard shot of 80-proof liquor (either straight or
in a mixed drink) or 5 ounces of wine.
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