nunc est bibendum

Now is the time to drink, or more colloquially, I'll drink to that. Alcohol and the ER.

Alcoholic beverages are part of all human cultures and have been made and shared from the earliest recorded human history. Wine, beer, whisky, vodka, aquavit, mead, ouzo, grappa, cognac, scotch, rye, bourban, etc...

We drink to celebrate, mourn, relax or just get buzzed. Religious ritual often involve the use of wine. Some religions use abstinence as part of their belief system. Societies and governments have tried to regulate and even abolish the use of alcohol with little effect.

Alcohol use causes an enormous number of deaths each year from MVC's, acute alcohol poisonings, and liver disease from chronic use. It contributes to innumerable tragedies from sexual assaults to domestic violence and suicide.

The world's oldest ER doc is not a teatotaler. Later tonight, I will be enjoying three fingers of a 15 year old single malt scotch while my saintly wife has a glass of wine. Alcohol in the form of red wine seems to have a beneficial effect in decreasing the risk of heart attack and stroke. Moderate drinkers live longer than non-drinkers.

The key is moderation. Even small amounts of alcohol can impair one's ability to perform complex tasks, especially driving. Thousands of deaths occur every year in the USA from drunk driving, usually refered to as DWI or DUI. Anecdotally, I have observed that, more often then not, the drunk driver is less severely injured then his or her victims. The ER doc's formula for calculating how much the DUI perpetrator imbibed is to multiply by 2 or 3 the number of drinks they admit to having had.

Working in an ER near to a large urban university guarantees a certain number of cases of acute alcohol poisonings. This is most common early in the school year among freshman. Make no mistake about it, alcohol is a poison. It impairs the central nervous system. From a mild disinhibiting effect to coma and airway compromise, the effects of alcohol are related to the amount, and the speed of ingestion. Chugging, binging, jello shots, high proof beverages all can raise one's BAL (blood alcohol level) to lethal levels.

Simply passing out while drunk, especially if lying face up, can lead to aspiration (anything but air getting into your lungs) with often fatal consequences. People will commit criminal acts while drunk that have real penalties. Being drunk is not a very effective defense. I have examined and treated too many young women and men who were assaulted after becoming incapacitated by alcohol ingestion.

Alcoholism is a disease. There are genetic variations that predispose some people to become dependent on alcohol. An alcoholic will experience withdrawal symptoms after as little as a few hours from their last drink. Tremors, tachycardia (rapid heart rate), sweating, anxiety, elevated blood pressure are all symptoms of early alcohol withdrawal. Hallucinations (DT's), seizures and death may occur. Treating alcoholism requires medical intervention and counseling. The rate of relapse is high. 12 step groups such as Alcoholics Anonymous work well for motivated individuals. Alcohol abuse may be a form of self medication for people with underlying pyschiatric disease. There are hospitals that can treat these dual diagnoses.

The drunk tank no longer exists. Otis the drunk in Mayberry would not be allowed to let himself into the sheriff's cell today. He would be brought to the ER. I examine, test and hold alcoholics in the ER almost every night. Their nutritional status and central nervous system are evaluated. Frequent blood tests, head CAT scans, and banana bags (an IV solution with vitamins added that turn the IV solution yellow) are often employed. I know many of the chronic alcohol abusing patient by first and last name. They are the epitome of the ER frequent flyers. The number of beds in alcohol treatment facilities is woefully inadequate. Alcoholics rarely have insurance. ER docs are legally and morally obligated to treat these patients but I feel like the little Dutch boy with his finger plugging the hole in the dike.

No moral to this story. Drinking alcoholic beverages is part of the human condition. Be responsible. Drink slowly and in limited amounts. DON'T DRINK AND DRIVE. Take a cab, call a friend or family member, or have a designated driver. The life you save may not be your own.