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FCA 0311 - EtOH

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Redwood Memorial Hospital Field Care Audit lecture on EtOH

Redwood Memorial Hospital Field Care Audit lecture on EtOH

Published in: Health & Medicine

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    • 1. Dying for a Drink: Case Study Veronica Bonales, M.D. CEP America Emergency Physician
    • 2. 1. Custom Search2. Intoxicated Pa. woman bites EMT3. Aug 9, 2010 ... By Valerie Waltz WPMT-TV HARRISBURG, Pa. A Harrisburg woman was arrested after biting an EMS worker. The incident happened early Saturday ...5. Intoxicated Kan. man steals ambulance6. Oct 12, 2009 ... UPI LAWRENCE, Kan. Police in Kansas said they arrested an intoxicated 21-year- old man who attempted to drive home in an ambulance left ...8. Intoxicated driver blamed for Maine paramedics death9. Aug 31, 2007 ... TURNER, Maine — The driver that caused an ambulance crash that claimed the life of a Wilton paramedic last month was intoxicated, ...11. Intoxicated man accused of assaulting Hawaii paramedic12. Nov 2, 2007 ... Intoxicated man accused of assaulting Hawaii paramedic ... Moiliili while treating a "severely intoxicated" 19-year-old man, police said. ...13. www.ems1.com/.../317502-Intoxicated-man-accused-of-assaulting-Hawaii- paramedic/14. Labeled EMS Products All Content16. Canadian medics told head trauma trumps intoxication17. Aug 17, 2010 ... By Clare Ogilvie The Province VANCOUVER, Canada A B.C. Coroners jury has recommended that more be done to look after people with head ...18. www.ems1.com/.../867643-Canadian-medics-told-head-trauma-trumps- intoxication/19. Labeled All Content21. Drunk NH woman allegedly attacks EMT22. Oct 6, 2010 ... The Concord Monitor WEARE, nh An intoxicated woman assaulted two police officers and an emergency medical technician Sunday in Weare, ...23. www.ems1.com/ems.../889233-Drunk-NH-woman-allegedly-attacks-EMT/24. Labeled All Content26. NM woman allegedly bit EMT27. Dec 18, 2010 ... LAS CRUCES, nm — Las Cruces police arrested a noticeably intoxicated woman who allegedly bit an emergency medical technician as he attempted ...28. www.ems1.com/ems-oddities/.../922675-NM-woman-allegedly-bit-EMT/29. Labeled All Content31. Pa. man charged for spitting blood on paramedic32. Oct 7, 2010 ... Police reported that the intoxicated man gave paramedics a hard time ... An intoxicated Brisson, who had a bloody mouth and cuts on his face ...33. www.ems1.com/.../890334-Pa-man-charged-for-spitting-blood-on-paramedic /34. Labeled All Content
    • 3. EMS & EtOH Patients2007 - NAEMT states 700,000 uncooperative patientencounters 52% injuries %om assaultsScene safetyAMAThe chronic alcoholic
    • 4. Lecture ObjectivesCase study Metabolism of alcohol Effects of alcohol on specific organ systems Pediatric special considerations CPI - History of alcohol EMS and alcohol
    • 5. JGCase Study
    • 6. JG21 year old femaleChief complaint: Abdominal painHPI: Two days of abdominal pain that radiates to theback. Taking Vicodin with no relief. Nausea andvomiting.
    • 7. JGPMHx: chronic alcohol abuse, alcoholic hepatitis,cholangitis secondary to cholelithiasis, pancreatitis, upperGI bleed, depression, polysubstance abuseSocial Hx: smokes a pack a day, drinks up to a ga)on ofvodka a day, polysubstance abuse including: methadone,methamphetamines, MJMeds: Vicodin - up to 4 a day
    • 8. EtOH – Ethanol
    • 9. Ethanol - EtOHVery simple carbon moleculeProbably discovered by accident 10,000 BCProduct of fermented sugars
    • 10. Beer“bibere” (L) = to drink
    • 11. BeerEarliest records Middle East about 6,000 years ago– Le- people feeling "exhilarated, wonderful and blissful."Made out of berries and honey“Cerveza” %om the Greek goddess of agriculture, Ceres
    • 12. EtOH MetabolismUp to 10% excreted in urine, sweat, breath90+% metabolized to acetaldehyde (toxic) by alcoholdehydrogenaseAcetaldehyde dehydrogenase in liver & GI tract breaksdown to acetic acid (non-toxic)
    • 13. EtOH MetabolismWomen have less ALDH in their stomachs than menOlder men have less ALDH than younger menSome people of Asian decent have a mutation of ALDH Quickly leads to acetaldehyde poisoning Develop a characteristic flushing of the skin and increased heart and respiratory rate *Mechanism behind Disulfuram
    • 14. EtOH Metabolism Average = 13ml of EtOH per hour
    • 15. EtOH IntoxicationState legal limit = 0.08 mg/dl Occasional drinker wi) be inebriated w/a level = 0.2, Coma/death/resp. arrest at levels of 0.3 – 0.4 mg/dl Alcoholics can reach levels of 0.7 mg/dl & be functional
    • 16. EtOH Intoxication Physical and Emotional Effect BAC 0.02 % You may feel relaxed and might experience slow reaction time. 0.04 % Your vision is affected. 0.08 % Your coordination decreases and your driving ski)s are impaired. This is the legal drinking limit. You are lega)y intoxicated and its i)egal to drive in the U.S. 0.10 % Your speech may become slurred. Lost of coordination and judgment. 0.15 % You may stumble when walking and may have trouble standing up. 0.30 % You might vomit and probably pass out. 0.40 % You may pass out (unconscious) and may go into a coma. Over 0.40 %Alcohol poisoning and death can occur. Your breathing might stop. This is the lethal blood alcohol level.
    • 17. Your Brain on EtOH• Glutamate • Dopamine ◦ Alcohol inhibits glutamate receptor function ◦ Alcohol raises dopamine levels ◦ This causes muscular relaxation, dis- ◦ This leads to excitement and stimulation coordination, slurred speech, sta0ering, ◦ Cocaine and amphetamine have similar effects memory disruption, and blackouts on the dopamine system ◦ Ether and chloroform have similar effects on the glutamate system • Endorphins• GABA (gamma-aminobutyric acid) ◦ Alcohol raises endorphin levels ◦ Alcohol enhances GABA receptor function ◦ This ki)s pain and leads to an endorphin ◦ This causes feelings of calm, anxiety- "high" reduction and sleep ◦ Morphine and heroin have similar effects on ◦ Valium has a similar effect on the GABA the endorphin system system
    • 18. AcetaldehydeSimilar to formaldehydeExcess spi)s over into bloodstream Inhibits mitochondrial functions Dec. metabolism of acetaldehyde to acetic acid, more acetaldehyde accumulates, & causes further liver damage Dec. oxidation of fatty acids leads to build-up Interferes with activation of vitamins (esp. Vitamin B1)
    • 19. EtOH Metabolism
    • 20. EtOH Metabolism
    • 21. EtOH Metabolism
    • 22. EtOH Metabolism
    • 23. EtOH Metabolism Problems w/excess NADH Overweight Fat breakdown (ETC) Lactic acidosis Takes pyruvate %om glucose cycle Hypoglycemia
    • 24. EtOH Metabolism Problems w/excess NADH Overweight Fat breakdown (ETC) Lactic acidosis Takes pyruvate %om glucose cycle Hypoglycemia
    • 25. EtOH Metabolism Problems w/excess NADH Overweight Fat breakdown (ETC) Lactic acidosis Takes pyruvate %om glucose cycle Hypoglycemia
    • 26. EtOH Metabolism Problems w/excess NADH Overweight Fat breakdown (ETC) Lactic acidosis Takes pyruvate %om glucose cycle Hypoglycemia
    • 27. EtOH Metabolism Problems w/excess NADH Overweight Fat breakdown (ETC) Lactic acidosis Takes pyruvate %om glucose cycle Hypoglycemia
    • 28. WineOenology - study of wine and wine-making
    • 29. Wine2700 BC wine symbols found in Egyptian drawingsNo vineyards, but traded with other cultures for grapesSoon developed their own lines of grapesWine-making quickly spread
    • 30. Liver
    • 31. Liver
    • 32. Fatty LiverWeekend fatty liver Bingers Acute, reversible fatty changes
    • 33. Fatty LiverWeekend fatty liver Bingers Acute, reversible fatty changes
    • 34. HepatitisAcute alcoholic hepatitis Due to mitochondrial damage, toxic effects of acetaldehyde (reduced antioxidants) Necrotic areas form, hypoxia-induced Fever, liver tenderness, jaundice Initia)y reversible
    • 35. CirrhosisIrreversible liver damageHard, shrunken liver Fibrosis %om chronic damage Weakness, muscle wasting, ascites, GI hemorrhage, coma
    • 36. Liver FunctionsOver 500 different functions! contro)ing levels of fats, amino acids and glucose (via glycogen) in the blood  combating infections in the body  clearing the blood of particles and infections including bacteria  neutralizing and destroying drugs and toxins  storing iron, vitamins and other essential chemicals  breaking down food and turning it into energy  manufacturing, breaking down and regulating numerous hormones including sex hormones  making enzymes and proteins which are responsible for most chemical reactions in the body, for example those involved in blood clotting and repair of damaged tissues
    • 37. JGPhysical Exam Vitals: Temp 36.8, HR 104, RR 16, b/p 74/55, 98% on RA, wt 54 kg A&O x 2 (person, place), skin jaundiced, sclera icteric, heart tachy, abdomen firm w/dec. bowel sounds & tender in epigastrum
    • 38. LabsWBC 7.8 Glucose 69Hb/Hct 10.3/30.3 Ca 7.2Platelets 90K Bili 21.3Na 126 AlkPhos 172K 3.2 AST/ALT 659/91Cr 3.2 Lipase 20
    • 39. LabsEtOH 79 U/AINR 2.4 + biliNH3 39 + nitritesUTox + ketones +acetaminophen + protein +methadone
    • 40. Shubat = fermented camel milkKumis = fermented mare’s milk
    • 41. Heart effectsCardio-protective in sma) amounts Increases HDL & decreases platelet a0regationAlcoholic cardiomyopathy due to acetaldehyde andEtOH’s direct effects on heart ce)s
    • 42. Holiday HeartAtrial fibri)ation most common arrhythmiaThought to be due to acetaldehyde and increase in fattyacids Prolongs PR, QRS, and QT intervalsMost common in young people a-er a weekend or“holiday” binge, but may occur a-er casual drinking
    • 43. Other effectsWernicke’s encephalopathy GI effects Thiamine deficiency – poor Gastritis nutrition Pancreatitis Ataxia, nystagmus Reproductive effectsKorsakoff syndrome Testicular atrophy Mammilary bodies Spontaneous abortion risk Confabulation increases
    • 44. TequilaTequila %om Nahuatl word “place of harvesting plants”
    • 45. TequilaMezcal wine made in 1521 %om agave plantOrigina)y for bandits & rancherosTequila vi)age founded 1656, export grew in 1700’s along trade route to ocean1758 – Jose Cuervo granted royal license to cultivate in region, 1880 se)ing10,000 barrels/year to local market alone1944 Mexican government began regulating– Only beverages brewed in region could be ca)ed tequila– Had to have at least 51% blue agave– Top brands are 100% blue agave
    • 46. FASFetal alcohol syndromeAcetaldehyde crosses the placenta Most damaging in first trimester Even one drink per day can cause Growth & developmental defects, facial dysmorphology (FAS facies), malformations of brain, CV system & reproductive organs
    • 47. FAS
    • 48. FAS
    • 49. Pedis and EtOHHypoglycemia and hypoglycemic seizures Loss of gluconeogenesis and sma)er glycogen storesClassic triad: coma, hypoglycemia, hypothermiaTrauma leading cause of death EtOH increases risk 3 - 7 times higherIncreases risk-taking behavior in a patient with slowed reflexes
    • 50. JGTo be continued.....
    • 51. ? Questions ?