Drinking Herself to Death

     It's a special-event weekend at the local university, and the Attack One crew has been responding to one call after another in the campus area. There have been some particularly large parties at the social clubs, and some larger-than-usual intake of alcohol at the parties and sporting events. Ambulances have been making frequent visits, and the ED's been busy each time the Attack One crew has been there. Just after the magic hour of 2 a.m., the dispatcher calls once more for a "possible alcohol poisoning."

     The crew arrives at a still-active event in one of the party houses and is guided to a young woman lying on a couch on the main floor. No one quite has a history of what happened. Bystanders can only report that she'd been there with friends, and has been sleeping on the couch "for a while." Her friends left, and now other party guests can't wake her up. No one even knows her name.

     Poor lighting and loud music make it difficult to assess the patient, so the crew decides to move her to the ambulance. They find a student ID card in her pocket, but she has no purse or other belongings. They load her onto the flexible patient sleeve and start to make their way to the front door. The patient arouses a little, makes some retching noises as though she's going to vomit, then becomes quiet again. As they get close to the door, another young lady appears. "Is this the girl who passed out from the barstool," she asks, "or the one who fell down the stairs?"

     No one knows, but the girl who asked the question thinks this girl's blonde hair matches that of the girl who fell unconscious off a barstool about two hours ago. She also thinks she knows some of the girls who came to the party with the patient. There is no one else still present who has any idea what happened.

     The patient is placed in the ambulance, and for the first time the paramedic can assess her. An EMT is dedicated to finishing work in the house, following up with the young lady who might have information about friends and sweeping the house to make sure there isn't another patient (the stair-faller) lying unconscious somewhere. A female campus security guard helps the crew look for additional identification on the patient. Nothing is found beyond the student ID, which gives her age as 21. The campus police have no access to parent contacts.

     The paramedic conducts the first full patient assessment in the ambulance. The original examination found no signs of trauma. The patient responds reliably by withdrawing from painful stimuli, and at times responds to loud verbal stimuli. Her pupils are equal, midsize and reactive. Her breath smells of alcohol. She is not incontinent of urine, and has no bite marks on her tongue. There are no signs of intravenous drug use. Fingerstick blood sugar is 112. On close secondary examination, a small contusion is noted on the left side of her skull.

     En route to the hospital, the girl opens her eyes briefly and again begins retching. The crew rolls her onto her left side in case she vomits. The patient's oxygen saturation improves on supplemental oxygen by nasal cannula. The only other change is a bump up in her blood pressure, to 154/90, just before arrival at the ED.

Initial Assessment

     A 21-year-old female, minimally responsive at a college party site.

     Airway: Marginal. Patient occasionally arouses and retches as though she's going to vomit.

     Breathing: Breathing regularly.

     Circulation: Normal capillary refill, pink skin.

     Disability: Arouses to painful stimuli, and occasionally to loud verbal stimuli. Pupils equal, midsize.

     Exposure of Other Major Problems: Bystanders unable to give a clear history, but someone believes she fell off a barstool.

Vital Signs

AMPLE Assessment

     Allergies: None known to bystanders; no alert bracelet.