Assessment

HISTORY. Ask the patient how much alcohol he or she consumed and over what period of time. Elicit a history of past patterns of alcohol consumption. You may need to consult other sources, such as family or friends, to obtain accurate information when the patient is acutely intoxicated on admission.

PHYSICAL EXAMINATION. The intoxicated individual needs to have a careful neurological, respiratory, and cardiovascular evaluation. In life-threatening situations, conduct a brief survey to identify serious problems and begin stabilization. Begin with assessment of the airway, breathing, and circulation (the ABCs).

RESPIRATORY. Assess the patency of the patient's airway. Check the patient's respiratory rate and rhythm, and listen to the breath sounds. Monitor the patient carefully for apnea throughout the period of intoxication. Determine the adequacy of the patient's breathing.

CARDIOVASCULAR. Check the strength and regularity of the patient's peripheral pulses. Take the patient's blood pressure to ascertain if there are any orthostatic changes. Check the patient's heart rate, rhythm, and heart sounds. Inspect for jugular distension, and assess the patient's skin color, temperature, and capillary refill.

NEUROLOGIC. Assess the patient's level of consciousness. The brief mental status examination includes general appearance and behavior, levels of consciousness and orientation, emotional status, attention level, language and speech, and memory. Conduct an examination of the cranial nerves. Assess the patient's deep tendon and stretch reflexes. Perform a sensory examination by assessing the patient's response to painful stimuli, and check for autonomic evidence of sympathetic stimulation. Check the adequacy of the gag reflex.

PSYCHOSOCIAL. Individuals admitted to the hospital during episodes of acute alcohol intoxication need both a thorough investigation of the physiological responses and a careful assessment of their lifestyle, attitudes, and stressors. Binge drinkers and dependent drinkers have complex psychosocial needs. Identify the patient's support systems (family and friends), and assess the effect of those systems on the patient's health maintenance.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Blood alcohol concen

Negative (<10 mg/dL

Positive (>10 mg/dL or

Legal intoxication in most

tration

or 0.01 g/dL)

0.01 g/dL)

states is 80-100 mg/dL

Carbohydrate deficient

0-26 units/L for

>20 units/L

Demonstrates excessive

transferrin (CDT)

women; 0-20 units/L

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