What are the complications of treating a drunk patient who is bleeding?

Brian G Turner

Brian G Turner

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Medical question with a long title. :)

Specifically: What are the complications of treating a drunk patient who is bleeding?

I figure issues of fluid loss through bleeding will be accentuated by dehydration caused by alcohol.

But ... I don't know whether this may cause any complications in the treatment and recovery, especially with serious blood loss - enough to begin circulatory shock (or close to it).

Any medical professionals in the house? :)
 
Not a medical professional, but with a high quantity of alcohol, there's the risk of it suppressing breathing (and this might limit the use of anaesthesia also,which also suppresses breathing.)

Doesn't alcohol also make you more prone to bleed, reducing clotting?

On the upside, alcohol I believe reduces your shock response by keeping the body more relaxed, I think.

But like I say, all hearsay that I think is true. Medical professionals to the rescue!
 
Hi,

Not an ER doc or anything but alcohol will have a number of effects, not least of which is on the patient. Getting an accurate history of what happened is going to be tricky at best, so you may not know if he's allergic to something. Equally he may not know that he's been stabbed etc. Add to that the fact that he may need to be restrained. Many drunk patients do attack ER staff.

Also the effect of the alcohol will be increased if he's lost significant amounts of blood, i.e. he could be even drunker than he is.

Fluid volumes, depending on what he's been drinking, beer as opposed to spirits, may be interesting. I.e. his fluid volume may be greater than it should be, because his body's absorbing the water from the drink to replace the missing blood. However this is just liquid not blood, so while it may help, its not going to do all the things that blood does, like carry oxygen.

And as TomG says alcohol does suppress breathing, which can play merry hell with a number of things like anaesthesia. Also some medications and alcohol don't mix well.

Cheers, Greg.
 
In sufficient quantities can cause permanent memory loss and more serious brain damage, especially when combined with a head injury. Cumulative being greater than the sum of the parts. (From what happened to a college student I heard of.)
 
A mixture of what the others have said. He'll already be dehydrated, although probably not that much compared to what the bleeding will do. If he's a chronic alcoholic and his liver is shot, he'll bleed more. Alcohol at high doses can suppress breathing. The alcohol will affect his mental state so that you can't be sure if the slurred speech is drunkenness or shock. And the co-operation issues of course.

If I can think of anything nobody else has said, I'll be back.
 
There is also the question of vomiting -- drinking a lot of alcohol can cause that. If the patient is lying face-up at the time, the vomit comes up, then gravity drags it back down. Down the airways. People have choked to death like that. I have seen someone in that state, and I rolled them face down so gravity was helping them clear their airways. It worked.

I'm assuming you have medical professionals treating your character? Believe me, they'll know when this happens, if my experience is anything to go by. Choking, coughing, convulsions...
 
How drunk is he, Brian? And how long has he being drinking this amount for?

And does he get annoyed when relatives comp-- no, wait. That's work. Just the first two questions then. Plus, where is he losing this blood from?
 
He's not used to drinking, but got very drunk - then someone tried to chop his head off.

He's unconscious, bleeding profusely from a shoulder/neck wound.

I just wondered if there are any physiological issues I would especially need to deal with because of the alcohol consumption.

I've already dealt with the breathing issue via a tracheotomy. :)
 
I said:
He's not used to drinking, but got very drunk - then someone tried to chop his head off.
Click to expand...

A typical Saturday night in Glasgow, then?

With no chronic alcohol use, excessive bleeding and memory loss won't be an issue. Co-operation and assessment of level of consciousness will be your main issues (but sounds like you've got him ventilated, which means he's probably kept under sedation), with dehydration a smaller issue (compared to the much bigger volume loss through bleeding).
 
I said:
I just wondered if there are any physiological issues I would especially need to deal with because of the alcohol consumption.
Click to expand...

At the moment of drunkenness probably not, but when the person sobers up there might be a lot of questions the others has to deal with. And the chances are that the victim might not even remember anything to happen to him. So finding out twenty stitches across a nasty wound might be a shock that possibly keep the person sane for a long, long time.
 
Intoxication causes vasodilation and having larger veins lead to modestly more bleeding. Your character has not complications of cirrhosis. The mild dehydration caused by drinking alone has little to do with bleeding and only a few percent increase to BAC concentration. Blood loss via a wound is also unlikely to increase intoxication. This is because the amount of blood lost becomes fatal before BAC can noticeably rise. Blood only makes up 7% of your body weight, you die after losing 2% or 3% of that. Alcohol absorbing tissue makes up over 70% of a person’s mass.

Shock would be moderated during intoxication as alcohol is a weak hypnotic similar to Benadryl or barbiturates. That’s why intoxication was historically used as anesthesia. It’s only moderated, you can still die from shock while intoxicated, while death due to shock is rare under true anesthetics. If you want your character to go into shock when they regain consciousness, that’s not abnormal.

There should be no unexpected issues and you can take the progress of the wound several ways. You can have at major neck wound and be up and walking around. With artery/vein damage it will quickly progress to fatal, but can clot even without treatment.
 
I said:
He's not used to drinking, but got very drunk - then someone tried to chop his head off.

He's unconscious, bleeding profusely from a shoulder/neck wound.

I just wondered if there are any physiological issues I would especially need to deal with because of the alcohol consumption.

I've already dealt with the breathing issue via a tracheotomy. :)
Click to expand...


A tracheotomy won't address respiratory depression, which is a side effect of acute alcohol intoxication. You need a respiratory stimulant.

Another side effect of high doses of alcohol is low blood sugar, which is further exacerbated by the profuse bleeding.

Here's an article about research on alcohol's effect on blood coagulation:

http://alcoholism.about.com/od/health/a/blacer051015.htm

It indicates that even moderate drinking leads to "thinning" of the blood, which will cause increased bleeding as blood doesn't clot so easily. However, it should be noted that this is based on long-term condition for people who drink regular amounts of alcohol, rather than the immediate effects of a single specific drinking event.
 
The tracheotomy is to specifically address the swelling of the major neck wound, which I presume could threaten to close the patient's airways.

I've tried to research on whether alcohol in the blood may cause particular problems for treatment in an emergency situation - but so far I'm drawing a blank, which surprised me. I guess dying is the far bigger threat. :)
 
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