Introduction to Alcohol Presentation

In most Western societies, including Australia, alcohol consumption in excess of medical guidelines is a socially acceptable past time. However, studies have shown that one in five Australians drink to excess on a regular basis and between 3 to 4% are dependent on, or abuse, alcohol (ABS 2012).

Alcohol abuse has many health-related consequences for which nurses and doctors in the emergency department are at the forefront to respond and treat.

In the emergency departments of Australia, 17 to 35% of all presentations are related to alcohol (Williams et al. 2011). Acute alcohol consumption is implicated in over 200 different health conditions as well as an increased risk of alcohol-related self-harm. Patients who present with acute alcohol intoxication in the emergency department can exhibit a range of clinical manifestations, including behavioural, cardiac, pulmonary, gastrointestinal, neurological, and metabolic effects.

Effect on Hospital Outcomes

Intoxicated patients generally require more intensive and thorough monitoring to ensure the highest standard of care is met. For instance, intoxicated patients often present with alcohol-related injuries - such as head trauma - as a direct result of intoxication. In these cases, patients are more likely to develop respiratory distress and thus require ventilator assistance. They are also more at risk of developing pneumonia and are more likely to require intubation as a result of their intoxication.

Alcohol abuse suppresses many parts of the immune system, which can lead to increased risk of infection (Happel et al. 2006). The course and resolution of bacterial and viral infections is severely impaired in alcohol-abusing patients, resulting in higher morbidity and mortality rates. The immunosuppressive effect of chronic alcohol ingestion also means greater care required from doctors and nurses in the ED.

How it Affects Nurses

Nurses are regularly reported to have a strong negative perception of alcohol-related presentations due to a range of issues. Primarily, this includes verbal and physical assault. Acute alcohol intoxication causes a clinically significant maladaptive behavioural change that often manifests itself with an unstable mood and impaired judgement. This results in impaired social functioning with inappropriate sexual or aggressive behaviour. Managing intoxicated and aggressive patients is distressing for all staff as well as being resource-intensive, thus affecting work schedules and other patients in the emergency department.

Furthermore, due to increased monitoring, there is an increase in the nurses’ workload. When an intoxicated patient presents at the emergency department, healthcare professionals need to do a physical examination, analysis of nutritional and hydration status, and determine the extent of alcoholism-related signs through chest, abdominal, and neurological examination.

The overall management of intoxicated patients therefore requires extensive effort to accurately identify and evaluate their clinical condition. Furthermore, the presence of any additional alcohol-related disorders will need to also be evaluated so that any personalised treatments that are necessary can be administered.

However, multiple factors can confuse the diagnostic picture, and so examinations must be repeated so as to choose the right therapy. Nurses also have to have increased vigilance over prescriptions, due to either reduced efficacy in the presence of alcohol, or accidentally provoking a negative clinical outcome.

Conclusion

Acute alcohol intoxication is a clinically harmful condition that can manifest with a variety of alcohol-related illnesses, all of which play a role in the emergency department workload burden.

References

Australian Bureau of Statistics 2012, Australian Health Survey: First Results, 2011-12, cat. no. 4364.0.55.001, ABS, Canberra, https://www.abs.gov.au/ausstats/abs@.nsf/lookup/4364.0.55.001main+features12011-12
Happel, KI, Bagby, GJ, Nelson, S, Odden, AR, Shellito, JE & Zhang P 2006, ‘Acute Alcohol Intoxication Suppresses the Interleukin 23 Response to Klebsiella Pneumoniae Infection’, Alcoholism, Clinical and Experimental Research, vol. 30, no. 7, pp. 1200-07, viewed 19 September 2016, https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1530-0277.2006.00144.x
Williams, M, Crozier, J, Jalaludin, B, Mohsin, M & Weber, D 2011, ‘Alcohol Consumption and Injury Risk: a Case-Crossover Study in Sydney, Australia’, Drug and Alcohol Review, vol. 30, no. 4, pp. 344-54, viewed 16 September 2016, https://pubmed.ncbi.nlm.nih.gov/21355919/

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