Tag Archives: alcohol

Alert! CDC Identifies Major Binge Drinking Problem

The Centers for Disease Control (CDC) released a report on binge drinking in the US last week that is quite alarming. It provides a host of facts that should alarm any trauma professional. And I’m fairly certain that these statistics apply to just about any other country as well.

The study indicated that 1 in 6 adults in the USA is a binge drinker! My understanding of the term binge is that 5 or more alcoholic beverages are consumed at one sitting. Obviously, this behavior puts one at risk for trauma, including interpersonal violence, car crashes, and injuries due to falls. About 80,000 people per year die due to this, and it costs our economy over $200B per year.

Here are some of the factoids that were uncovered:

  • The highest number of binge drinkers was in the 18-34 year age group 
  • The 65+ year age group drank the most during a binge (!!) 
  • Most alcohol-impaired drivers were binge drinking (!!!) 
  • The average highest number of drinks consumed during a binge was 8. In an average drinker, the resulting blood alcohol concentration would be about 0.24 mg/dl, or 3 times the legal limit. 
  • The northern tier states tended to have the most binge drinkers (18-25%)

What can trauma professionals do? In the US, all Level I and II trauma centers verified by the Amican College of Surgeons are required to screen all patients for problems with alcohol. This requirement should be adopted at all centers, regardless of country or level. Additionally, specific prevention programs should be developed, and existing community programs should be supported.

Reference: CDC Vital Signs -Jan 2012

Drug Use and Automobile Crashes

All trauma professionals are keenly aware of how often alcohol is involved in automobile crashes. Something you may not know is that one third of drug tests for other substances are positive in drivers involved in car crashes!

There has been a 5 percent increase in the number of positive drug screens in drivers over the past 4 years. The drugs range from hallucinogens to prescription pain medications. 

Seventeen states have enacted legislation making it illegal to drive while on various types of legal and illegal drugs. However, these laws are difficult to enforce because:

  • They are more difficult to detect, both by law enforcement at the scene and in the hospital
  • We don’t know a lot about the impact of these drugs on driving performance
  • A positive drug screen does not tell us when the substance was taken and if it is at a significant level

Drug screens are typically obtained in the ED in seriously injured drivers. It’s a good idea to order one in any patient with a significant head injury. This allows the clinician to guess (and it’s just a guess) that the medications may be impairing the mental status exam. Any patients who have a positive screen should have a documented chemical dependency evaluation and be provided with referral information to get further help.

Reference: National Highway Traffic Safety Administration


CIWA Demystified

What exactly is the CIWA protocol?

It is a tool used commonly in the US that helps clinicians assess and treat potential alcohol withdrawal. A significant amount of injury in this country is due to the overuse of alcohol. A subset of these patients are admitted and do not have access to alcohol. They may begin to withdraw within a few days, and this condition can lead to dangerous complications.

The Clinical Institute Withdrawal Assessment measures 10 items that are associated with withdrawal:

  • Nausea / vomiting
  • Anxiety
  • Paroxysmal sweats
  • Tactile disturbances (itching, bugs crawling on skin, etc)
  • Visual disturbances
  • Tremors
  • Agitation
  • Orientation
  • Auditory disturbances
  • Headache

All items are measured on a scale of 0-7 with the exception of orientation, which uses a scale of 0-4. All subscores are tallied to arrive at the final score.

The total score is used to determine whether benzodiazepines should be given to ameliorate symptoms or avoid seizures. Typically, a threshold is selected (8 or 10) and no medications are needed as long as the patient is under it. Once it is exceeded, graduated doses of lorazepam or diazepam are given and vital signs and CIWA scores are repeated regularly. The protocol is discontinued once the patient has three determinations that are under the threshold.

The individual dosing scale and monitoring routine varies by hospital. Look at your hospital policy manual to get specifics for your institution.

For a copy of the CIWA scoring criteria, click here.