What Precentage of EM patient Population is intoxicated?

[Futuredoctr]

I was seriously thinking about EM until I started to notice a very disturbing trend--> a good precentage of patients are intoxicated with some substance be in alcohol or drugs. From those of you working in EM, can you put a finger on how many patients you see that you really never interact with becuase they are so intoxicated.

Do you find this a negative thing, or a plus?

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[roja]

You always interact with patients, regardless of etoh or drugs.

The percentage is going to vary with the hospital setting you are in. But it doesn't matter WHAT field (except maybe path and rads) where you won't have to deal with drug and alcohol patients.

 

[keeping-it-real]

Did I miss the clause in my residency contract where I don't have to see intoxicated patients? What about patients who have been waiting too long and are complaining too much?

To the OP, we see and interact with every patient that comes into the ER, regardless of mental status or how pleasant they are. As far as the number of acutely intoxicated patients in an ER at any time, it's probably 10% or less...higher in the late night crowd and less in the mid-day crowd. You shouldn't let one issue like this dissuade you from considering EM, though.

 

[USCDiver]

In reality, the percentage of patients who are intoxicated is less than 5%. If you add in the number who have been drinking alcohol or doing drugs, but are not intoxicated it might be 10%. Think of it this way: for every passed out drunk I see, I will see at least 5 chest pains, 5 abdominal pains, 5 shortness of breaths and 5 vaginal bleeders. Probably see another 10 minor pain complaints during that time as well (ankle sprain, back pain, minor MVC, etc).

 

[docB]

I put 40 to 60% but that was before I read the part about "patients you never interact with." The number of patients I never interact with because of their intoxication is very low. That would only be the ones I admit because they're so blotto they will need longer than a shift to get walking or the ones I have to intubate. I'd say that's only 1-2%.

I put ~50% beacuse that is the number of patients I see who have some component of intoxication, abuse or addiction to their problems. Etoh, percocet, methadone and all of the resultant trauma, withdrawals, constipation, etc. Yeah, 50%.

Just to make the point I've been here about 2 hours so far and I've seen 10 people. Here's my list:

50 yo M here for N/V/D due to narcotic wds, ran out of MS contin.

23 yo M schizophrenia exacerbation, stopped meds, took meth instead.

64 yo F with CVA - No intoxication issues!

47 yo M with heroin OD, shooters abscess, sent from jail.

54 yo M altered, not sure why yet (probably septic) but not intoxicated!

26 yo M chest pain, SOB, in rhabdo from etoh and coke.

56 yo F chronic hip pain and constipation, on OxyContin and Percocet, she just can't understand why she's constipated.

44 yo F finger fracture 3 weeks ago, here for refill of Lortab.

74 yo F dialysis cath issue - No intoxication issues!

77 yo M with IC Bleed - No intoxication issues!

So that's 60% for me today.

 

[SoCuteMD]

In reality, the percentage of patients who are intoxicated is less than 5%. If you add in the number who have been drinking alcohol or doing drugs, but are not intoxicated it might be 10%. Think of it this way: for every passed out drunk I see, I will see at least 5 chest pains, 5 abdominal pains, 5 shortness of breaths and 5 vaginal bleeders. Probably see another 10 minor pain complaints during that time as well (ankle sprain, back pain, minor MVC, etc).

I think 5% is an incredibly LOW estimate. That may hold true in your catchment area, but has not been my experience at all. Where I've been (major city level 1, big trauma center, and major city level 2) it varies widely. Daytime - less than 5%. Night time - depends on the center - in the big city level 1 and trauma center it was usually at least 20%. In the level 2 center, closer to 10%. Weekend nights that climbs to probably 30% and 15% respectively (lots of driving under the influence, car crashes, etc.).

I "interact" with every patient - intox or not. If you are too drunk to interact with me then you likely will end up with some serious intervention - but I've never had an intox patient that I truly could not arouse (yet).

 

[WallowaWanderer]

It is going to vary a lot depending on where (suburban vs. inner city) you practice.

I heard a good quote the other day "If you do not find the alcoholic a fascinating clinical case then you should not go into emergency medicine."

We have alcohol to thank for a ton of cool pathology.

 

[gutonc]

We have alcohol to thank for a ton of cool pathology.

"To alcohol: the cause of --- and solution to --- all of life's problems."
- Homer Simpson

 

[njac]

It is going to vary a lot depending on where (suburban vs. inner city) you practice.

I heard a good quote the other day "If you do not find the alcoholic a fascinating clinical case then you should not go into emergency medicine."

We have alcohol to thank for a ton of cool pathology.

that's a great outlook. I'll have to remember that.

I'm on rotation at the only Level 1 trauma center in a very poor, very rural state with an astonishing EtOH and opiate problem. I put 40-60%. I think that's probably what they average. Although I giggle every time I see "EtOH Assault" as the CC on the computer. I always assume someone was beaten with a beer bottle or sprayed with champagne.

 

[nymbarra]

A good proportion of patients have EtOH / drug abuse issues, but for me it seems like under 5-10% come in floridly intoxicated.

We make sure they don't have any other medical issues, let them metabolize, and go see other patients...

A lot of times when you do engage these patients, they will tell you about their domestic abuse, homelessness, unemployment, psychiatric issues, etc.

These are much broader societal and public health issues that we generally don't have the capacity to deal with in the ED. And that's why social work and psych are so fantastic.

However, having these interactions gives us a really good perspective on the problems with healthcare, so you're prepared to (if you want to) tackle these issues outside of the ED, ie in a public health / advocacy project.

 

[roja]

I put 40 to 60% but that was before I read the part about "patients you never interact with." The number of patients I never interact with because of their intoxication is very low. That would only be the ones I admit because they're so blotto they will need longer than a shift to get walking or the ones I have to intubate. I'd say that's only 1-2%.

I put ~50% beacuse that is the number of patients I see who have some component of intoxication, abuse or addiction to their problems. Etoh, percocet, methadone and all of the resultant trauma, withdrawals, constipation, etc. Yeah, 50%.

Just to make the point I've been here about 2 hours so far and I've seen 10 people. Here's my list:

50 yo M here for N/V/D due to narcotic wds, ran out of MS contin.

23 yo M schizophrenia exacerbation, stopped meds, took meth instead.

64 yo F with CVA - No intoxication issues!

47 yo M with heroin OD, shooters abscess, sent from jail.

54 yo M altered, not sure why yet (probably septic) but not intoxicated!

26 yo M chest pain, SOB, in rhabdo from etoh and coke.

56 yo F chronic hip pain and constipation, on OxyContin and Percocet, she just can't understand why she's constipated.

44 yo F finger fracture 3 weeks ago, here for refill of Lortab.

74 yo F dialysis cath issue - No intoxication issues!

77 yo M with IC Bleed - No intoxication issues!

So that's 60% for me today.

This is why I refused to come to vegas

 

[GeneralVeers]

This is why I refused to come to vegas

It's not so bad. Some of the pluses:

- Good salary (for large metro area)
- Good weather (i.e. no snow)
- Housing bargains
- No state income tax
- Near Southern California
- Everything is open 24 hours (great in between night shifts)
- Lee's Discount Liquor

 

[DrMom]

It's not so bad. Some of the pluses:

- Lee's Discount Liquor

Very appropriate mention for this thread!

 

[docB]

This is why I refused to come to vegas

This really isn't that different than when I was at UC Davis. Sacramento has a HUGE meth problem and the tweakers were about an every fifth patient kind of issue. It was a really heavy trauma center as well and so much trauma has intoxication as a starting point. I think that if you look at the overall number of ED visits across the country that have substance abuse components it's a really high number.

BTW - the boys have adapted to it really well so it can't be that different than NY either.

 

[docB]

- Lee's Discount Liquor

Very appropriate mention for this thread!

Lee's is a Vegas thing like In-N-Out is a California thing. They are a chain of these mini wherehouse type places that sell every kind of booze, beer, kegs and wine. Mr. Lee and his son do these wacky, slap-stick TV ads that are so poorly done they're hilarious. It's the closest thin Vegas has to culture if you don't count Circ Du Solil which most people don't.

 

[GeneralVeers]

Lee's is a Vegas thing like In-N-Out is a California thing. They are a chain of these mini wherehouse type places that sell every kind of booze, beer, kegs and wine. Mr. Lee and his son do these wacky, slap-stick TV ads that are so poorly done they're hilarious. It's the closest thin Vegas has to culture if you don't count Circ Du Solil which most people don't.

I just like the "cheap wines from Eastern European countries I've never heard of section".

 

[DrMom]

Lee's is a Vegas thing like In-N-Out is a California thing.

mmmmm. In-N-Out

last night I had a drunk who was very slow in clearing his ETOH. he must have been drinking right up until he was transported to us. We nearly tapped him, then he finally started coming to (this was something like 8 hrs into his ER visit). He was listed on our tracker board as cc:"too drunk to fish"

 

[deleted65604]

I intubated a girl in the ER for being intoxicated (GCS 4). I was about to admit her when she woke up and started asking for the tube to come out. So I took it out and watched her until she could walk. We had to wait a few hours for her parents to show up since they lived 6 hours away. First time I've ever extubated someone in the ER.

 

[spyderdoc]

This is why I refused to come to vegas

That's exactly what I was thinking!

 

[GeneralVeers]

That's exactly what I was thinking!

Well maybe Vegas doesn't want you anyway. Probably puritans.

 

[deleted109597]

So, here in my neck of the woods, the local constabulary has decided a couple of things. 1. Drunk people can't just be, you know, drunk. Even if they are asleep, they need to be awakened and taken somewhere.
2. They don't want to deal with them, so they give the drunkards two options. Jail or the hospital. Guess where most people choose?
We have a fair number of people that clog up hallway beds on the weekend because cops bring all drunk people to the emergency department. We send them on their merry way as soon as they can get someone to show up that is sober and agrees to be responsible for them.

 

[docB]

So, here in my neck of the woods, the local constabulary has decided a couple of things. 1. Drunk people can't just be, you know, drunk. Even if they are asleep, they need to be awakened and taken somewhere.
2. They don't want to deal with them, so they give the drunkards two options. Jail or the hospital. Guess where most people choose?
We have a fair number of people that clog up hallway beds on the weekend because cops bring all drunk people to the emergency department. We send them on their merry way as soon as they can get someone to show up that is sober and agrees to be responsible for them.

The old "Jail or ER" choice is quite popular with the Las Vegas Metropolitan Police Dept. as well.

 

[spyderdoc]

Probably puritans.

Huh? I missed that one....

Well, we sure get our fair share of druggies (tons of meth...) and drunks here in San Jose as well....Last night, I saw 30 pts, and I'd say 18-20 of them had susbstance "issues"....

I'm sure tonight will be a psychos are us night with the full moon....

Cheers!

 

[roja]

This really isn't that different than when I was at UC Davis. Sacramento has a HUGE meth problem and the tweakers were about an every fifth patient kind of issue. It was a really heavy trauma center as well and so much trauma has intoxication as a starting point. I think that if you look at the overall number of ED visits across the country that have substance abuse components it's a really high number.

BTW - the boys have adapted to it really well so it can't be that different than NY either.

Thankfully here in San Fran (*cough* heaven *cough*) we don't have those same socal elements.

The boys are looking way to sleek. Way to much money and to much time off. I think you should give them MORE work. They were playing games to see which one of them had to cover the 800$ dinner/drink tab the last time I saw them... way to much money...

It's not so bad. Some of the pluses:


- Near Southern California

this is a plus?

I actually considered it but the down side was I didn't want my 8 year old to grow up thinking dancing on a pole was a 'professional option'.

 

[leviathan]

Just got off night shift...unusually slow night:

48y/o female N/V/D, no intoxication
21y/o female deep finger laceration, no intoxication
74y/o female post cardiac sx CP, no intoxication
79y/o male CP, no intoxication
75y/o female weak+dizzy+melena, no intoxication

That's 0% for me....but usually it is up to 20%.