OK, so the patient is drunk. Some then might say that the blood alcohol level is obtained to determine the level of intoxication. I honestly believe that the term “blood alcohol level” almost implies a correlation between intoxication and the number (level). We know that the effects of alcohol are very idiosyncratic; everyone experiences a different response based on a multitude of factors, including their level of exposure, comorbidities, previous exposure, etc. Historically, we believed that the number could be applied to a formula to predict clearance. This has been disproved. Furthermore, Roberts and Dollard published an article in 2010, and the conclusions are words to live by: “Attempting to relate observed signs of alcohol intoxication or impairment, or to evaluate sobriety, by quantifying blood alcohol levels can be misleading, if not impossible.”9
Explore This IssueACEP Now: Vol 34 – No 01– January 2015
The only reliable test for determining the level, or degree, of intoxication is the physical examination. In other words, if you can carry on a normal conversation, your judgment and insight are reasonable, and your motor function is not impaired (eg, ambulation without difficulty, no slurred speech), you’re not clinically intoxicated. Having all of the providers agree to this assessment in the medical record is key to avoiding discrepancies. However, adding an unnecessary blood alcohol level into the diagnostic picture only serves to cast doubt on your clinical determination that the patient wasn’t impaired. Impairment is the key, not a specific number. Remember, the legal level of intoxication (different from state to state) relates to a person’s ability to legally operate a motor vehicle in that state. This arbitrary level has no clinical basis and should not be applied in the world of clinical medicine.
Unnecessary blood alcohol levels in the medical record may cast doubt on your clinical assessment and may obviate you to observe your patients for extended periods of time while waiting for them to achieve a level for safe motor vehicle operation in your state, a number irrelevant to the clinical management of your patient.
Dr. Klauer is the chief medical officer-emergency medicine and chief risk officer for TeamHealth as well as the executive director of the TeamHealth Patient Safety Organization. He is an assistant clinical professor at Michigan State University College of Osteopathic Medicine; Speaker of the ACEP Council; and medical editor in chief of ACEP Now.
- Davis M, Nakhdjevani A, Lidder S. Suture/Steri-Strip combination for the management of lacerations in thin-skinned individuals. J Emerg Med. 2011;40:322-3.
- Stub D. A randomized controlled trial of oxygen therapy in acute ST-segment elevation myocardial infarction: the Air Versus Oxygen in Myocardial Infarction (AVOID) study. Presented at: American Heart Association Scientific Sessions; Nov. 19, 2014; Chicago, IL.
- Brown OR, Huggett DO. Effects of hyperoxia upon microorganisms. Appl Microbiol. 1968;6:476-9.
- Niijima S, Shortland DB, Levene MI, Evans DH. Transient hyperoxia and cerebral blood flow velocity in infants born prematurely and at full term. Arch Dis Child. 1988;63:1126-30.
- McNulty PH, King N, Scott S, et al. Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization. Am J Physiol Heart Circ Physiol. 2005;288:H1057-62.
- Cabello JB, Burls A, Emparanza JI, et al. Oxygen therapy for acute myocardial infarction. Cochrane Database Syst Rev. 2010;(6):CD007160.
- Cornet AD, Kooter AJ, Peters MJ, et al. Supplemental oxygen therapy in medical emergencies: more harm than benefit? Arch Intern Med. 2012;172:289-90.
- Arruda-Olson AM, Roger VL, Jaffe AS, et al. Troponin T levels and infarct size by SPECT myocardial perfusion imaging. JACC Cardiovasc Imaging. 2011;4:523-533.
- Roberts JR, Dollard D. Alcohol levels do not accurately predict physical or mental impairment in ethanol-tolerant subjects: relevance to emergency medicine and dram shop laws. J Med Toxicol. 2010;6:438-42.