Gastric emptying in the acutely inebriated patient

Gastric evacuation for acute ethanol intoxication in a three year old

A three year old girl presented in a deeply comatose state. She had drunk ethanol four hours previously and her blood ethanol concentration on arrival was 79.8 mmol/litre (3.69 g/litre). Because of her young age, high blood ethanol concentration, time since ingestion, and severe neurological depression on presentation, nasogastric aspiration of the stomach contents was performed and 4.2 g of ethanol were removed. She made an uneventful recovery.

Severe ethanol intoxication in an adolescent

A 15-year-old boy presented to the emergency department with status epilepticus and a blood ethanol concentration of 757 mg/dL. Mechanical ventilation and substantial amounts of benzodiazepines were required. His hospital course was complicated by aspiration pneumonia, but he had no episodes of hypoglycemia. He received 2.8 hours of hemodialysis, which increased the rate of ethanol elimination, but there is no evidence that hemodialysis improved his clinical outcome. To our knowledge, this is the highest blood ethanol level reported in a child or adolescent who survived.

Intoxicated airline pilots: a case-based ethics model

The ethical dilemma of managing two intoxicated airline pilots who insist on flying a commercial plane after leaving the emergency department is presented. The case explores the issues surrounding duty to warn, decision-making capacity, breaching confidentiality, and the requirements of law. A useful ethical decision-making model is reviewed to address the responsibility of the emergency physician to intervene and the options available.