So I’m pretty sure that in the weeks I have been here, this last weekend was my first weekend working nights. So I worked both Friday and Saturday nights. Sorry I haven’t posted since then but I had to get ready for a facilitation that was today — and I’m pretty sure we nailed it. So before I get onto my scholarly research paper – due next Tuesday I’ll tell you about my weekend in the ER.
For those who know me, I enjoy a few bevvies, either after a long day or with friends. And I enjoy different things, for example in my fridge right now I have a bottle of Baileys, some canned extra spicey Cesars, and some Mill Street beer that the boy bought when he was here in Sept. Oh and I still have 10 bottles of wine left.
So a relatively boring bar when compared to the different options I could offer you if you popped over to the house. But there is also a major alcohol problem here, could that be causing my subconscious to repel the fun feeling of drinking wine and jump right to the hangover? Perhaps…
I’ve mentioned in previous posts that SL is the hub to alot of communities further north, that being said SL is a big city to people. And if someone is ill enough to be transferred here most times the insurance company will allow for an escort to accompany the patient. Sometimes the pull of the big city is strong and adults partake in a few too many adult activities and it happens that the insurance company finds out and cancels the coverage – that means no more paid accommodation, or food for the resident of the northern community and/or escort. Now that strands this person in SL, and so begins the snowball.
Now I may have been enjoying a cost effective alternative to the pricey wine club I was once in (But I found a few reds I really enjoy drinking and for a student, sometimes cheaper wins) but the drink of choice up here is also a cost effective red wine, that when a paramedic first described it to me sounded like that beer I drank as a teenager, you know the one – large plastic bottle, higher then normal alcohol content and dirt cheap. So when dispatch calls ahead that we are getting a patient with “intox” we usually try to clear a room and the most concise report we receive when they arrive is that the person is into the Kelly’s. I worked my first full weekend in the Emerg last weekend and 90% of the patients that came in for treatment wither on their own, via EMS or OPP were intoxicated. A few were related to other substances but most were etoh.
Lets talk a little bit about how the measurement of ethanol in the blood is measured. I’ll try to keep it simple.
Gotta start with the American values – sorry, lost my best lab source in the computer crash of September, so I’ll talk it around. The legal limit is 80 mg of ethanol in 100 ml of blood = (0.08) anything greater then that is considered impaired driving – you’re with me still right.
Let me convert this information back for you into Canadian values.
50 mg of ethanol into 100 ml of blood = 0.05% circulating in your blood = level of 10.9 mmol/L, so we would be waiting for that number – 10.9
When the amount of alcohol reaches 0.4-0.5 % of your total circulating volume = 86-108 mmol/L is toxic to your body, there is an increased chance of alcohol poisoning.
So based on those values, that is what you would expect to see clinically when a patient arrives, so if you were to guess an alcohol level based on the presentation of the person coming through you know what to look for — right? Well… what that doesn’t say is that people with chronic alcohol consumption present differently.
The highest alcohol level I have seen here in the Emerg is 104 – and this person received a few hours of IV fluid, an amp of D50, some Thiamine (Vit B) we monitored his breathing on the cardiac monitor and made sure he wasn’t going to fall off the stretcher, but we woke up after about 3 hours and left against medical advice. Now seeing a blood value like that in a city that has a hospital with an ICU, a physician may want the patient monitored there and potentially intubated for breathing. <<Potentially, of course>> This same patient returned to the department the next night – relatively well but with his girlfriend who was going through withdrawls, she explained that she had been drinking for a month straight and had lost a newborn baby born prematurely 5 weeks ago to child services. I administered some Valium per CIWA protocol as her tremors were so bad the lab could not even draw blood.
Being here as short a time as I have I don’t recognize the regulars. We see alot of addiction and substance abuse in Southern Ontario, don’t get me wrong I realize this is not isolated to this region however I have never seen a person who is only recently legally old enough to consume alcohol in the United States be in complete liver failure. This patient cried to family about liver failure and when the blood work came back the etoh level was over 80 mmol/L. This person is jaundiced and looks as though is 9 months pregnant with the size of her belly – no baby just fluid displaced from the ineffective liver.
This has been my learning curve lately working more weekend nights, and not entirely related today is Day 3 of my 7 day Reset Challenge. I have been etoh and sugar free and really trying to establish some healthy habits. I can’t say that I feel any differently at this point but it is so difficult to track short bursts like this – I’ve been on nights so my sleep is disturbed and that is a whole different post on how sleep effects your overall body system.
Now I have to get back to finishing my research paper, my team killed an ER nursing related facilitation that was attempting to teach L4 nursing students what it is like to work in the Emerg — thanks to everyone who helped me prepare!
Hope you enjoyed the science lesson, and just know that because I removed the booze from my immediate living space I’m sure gonna continue to crack some wine with dinner again next week. Have you ever given up something like booze or sugar? How did it go?
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