What alcohol level do you admit for?

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Nothing drives me more crazy than the drunks. We have people that bring in their friends who are fine, but have an alcohol level of 200, so we admit them overnight for IV fluids. What level does your ER keep patients from, assuming everything else about the patient is fine?

Jessica

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Specializes in Cardiac, ER.

We don't really have a "level",.if the pt is able to breathe on their own, and able to walk on their own to the car and there is a sober driver they are free to go! Now if you request to be admitted for detox we keep you,.if you fall asleep and your Sat's drop into the 70's we will keep you only until you sober up a bit.

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Specializes in Emergency Dept, M/S.
We don't really have a "level",.if the pt is able to breathe on their own, and able to walk on their own to the car and there is a sober driver they are free to go! Now if you request to be admitted for detox we keep you,.if you fall asleep and your Sat's drop into the 70's we will keep you only until you sober up a bit.

That is our policy also. It's hard, because we have some "walkie/talkie/pretty coherent" drunks that are .20 or greater. I've seen it a bit higher, but heard of some with unreal levels!

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Specializes in Emergency & Trauma/Adult ICU.
Nothing drives me more crazy than the drunks. We have people that bring in their friends who are fine, but have an alcohol level of 200, so we admit them overnight for IV fluids.

Am I understanding correctly that the admitting dx for these patients is "intoxication w/ BAC of > 0.20"??

Wow.

With that admitting dx we could fill up the entire hospital every weekend, every holiday, day before & after the holiday, every first of the month, and every time there's a concert/festival/parade/other large public celebration.

No one gets admitted here simply for intoxication. One of our regulars is brought in a few times a month with a BAC > 450. This individual gets discharged around the time that they're likely around the 200 point, because if they drop much below that, they'll be seizing.

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We also don't admit for detox. Our docs philosophy is "come back when you're sober and tell me you wanna stay that way." I agree 100%, too many people take up space in my ER drunk and claiming they want help, taking up resources, only to "sober up", change their minds and go AMA:twocents:

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I work in a drug and ETOH detox rehab hospital. Not much can frustrate one more than careing for the addicted Pt. I need to say that when a person presents with a BAL higher than whatever the legal limit is in that state and asking for help then one accepts a tremendous liability by D/C that person back into the public legally intoxicated.

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Specializes in Med-Surg.

Don't levels vary from person based on their history. Someone might have a tolerance and be walking around with a level of 200, but for someone like me who hasn't drank in a long time, I'd be falling down drunk.

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Specializes in ICU/ER.

It totally depends on how many beds we have open---if we are low census, they will admit anyone!!! If we are full, we keep them till they sober up some and Sats remain above 92 or RA.

FYI I dont really mind the drunks they just sleep. But I work nights so I know the day staff does not like having them there, as they want to get out ASAP and dont like having to wait for a Dr or BH consult. As if they are admited for ETOH they get a BH consult..

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Another thing you might consider is calling a family member or friend of the intoxicated Pt. to come and get them. Doesn't work every time, but every once in a while helps. I agree that lots of alcoholics just want to sleep it off, some believe they are great lovers. When that is the case you can call the police fearing the Pt has laid hands on the nurse. Doesn't work every time but every once in a while helps.

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

no particular level in our ER since the number doesn't really matter, what does matter is that the patient can protect thier own airway or not. If they can, we may give fluids and send them on thier way out the door when they are sober enough (most of them run for the exit when they are awake enough anyway). If they cannot protect thier airway and require intubation (not that common)then obviously they get admitted.

Sweetooth

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Specializes in Emergency & Trauma/Adult ICU.
I need to say that when a person presents with a BAL higher than whatever the legal limit is in that state and asking for help then one accepts a tremendous liability by D/C that person back into the public legally intoxicated.

I'll clarify. The individual I described in my example does not come in "asking for help" -- they are brought in by police or medics when they fall in or near the bar or otherwise do something that brings them in contact with police or EMS. So far, this individual has not required admission for an injury or other comorbidity and refuses all suggestions of detox/rehab.

The rule of thumb with our typical daily contingent of breakfast clubbers is ... when you've been in the ER long enough to metabolize enough ETOH to drop to 100 or below, can ambulate steadily, tolerate p.o. intake, and are alert enough to start wondering out loud, "Where the **** is my cell phone??" ... it's time for you to go. Or ... when a sober friend/family member shows up to get you.

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Specializes in Emergency & Trauma/Adult ICU.
Don't levels vary from person based on their history. Someone might have a tolerance and be walking around with a level of 200, but for someone like me who hasn't drank in a long time, I'd be falling down drunk.

Exactly.

I'd likely be unconscious before I got to 200, but others can be alert & oriented at over 300.

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