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1.
J Stud Alcohol Drugs ; 81(4): 505-510, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32800088

RESUMO

OBJECTIVE: Sensing the effects of alcohol consumption in real time could offer numerous opportunities to reduce related harms. This study sought to explore accuracy of gait-related features measured by smartphone accelerometer sensors on detecting alcohol intoxication (breath alcohol concentration [BrAC] > .08%). METHOD: In a controlled laboratory study, participants (N = 17; 12 male) were asked to walk 10 steps in a straight line, turn, and walk 10 steps back before drinking and each hour, for up to 7 hours after drinking a weight-based dose of alcohol to reach a BrAC of .20%. Smartphones were placed on the lumbar region and 3-axis accelerometer data was recorded at a rate of 100 Hz. Accelerometer data were segmented into task segments (i.e., walk forward, walk backward). Features were generated for each overlapping 1-second windows, and the data set was split into training and testing data sets. Logistic regression models were used to estimate accuracy for classifying BrAC ≤ .08% from BrAC > .08% for each subject. RESULTS: Across participants, BrAC > .08% was predicted with a mean accuracy of 92.5% using logistic regression, an improvement from a naive model accuracy of 88.2% (mean sensitivity = .89; specificity = .92; positive predictive value = .77; and negative predictive value = .97). The two most informative accelerometer features were mean signal amplitude and variance of the signal in the x-axis (i.e., gait sway). CONCLUSIONS: We found preliminary evidence supporting use of gait-related features measured by smartphone accelerometer sensors to detect alcohol intoxication. Future research should determine whether these findings replicate in situ.


Assuntos
Acelerometria/métodos , Intoxicação Alcoólica/diagnóstico , Testes Respiratórios/métodos , Marcha , Smartphone , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
2.
Sud Med Ekspert ; 63(3): 35-39, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597609

RESUMO

The aim of work is to study dynamics of frequency of alcohol intoxications incidence revealed at forensic examination of corpses in Moscow. Frequency of intoxications incidence was determined as index making a share part of cases where ethyl alcohol was found in blood of corpses, comparing to total number of forensic autopsies. For every calendar year of the five-year period from 2014 till 2018 the comparative analysis of frequency of incidence of alcohol intoxications at concrete types of death was carried out. We defined the trend and the rate of changes of alcohol intoxications frequency. During the period from 2014 to 2017 we discovered the strong tendency to reduction of number of alcohol intoxications at violent death. In 2018 the rate of reduction decreased.


Assuntos
Intoxicação Alcoólica , Intoxicação Alcoólica/diagnóstico , Autopsia , Etanol , Humanos , Moscou/epidemiologia
3.
Psychopharmacology (Berl) ; 237(7): 2213-2230, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32382783

RESUMO

RATIONALE: Witnesses and victims typically provide the central leads in police investigations, yet statistics from past research indicates in many instances these individuals are intoxicated. OBJECTIVES: To date, however, no research has looked at how best to interview such witnesses to maximise the amount of accurate information they recall. METHODS: In the present research, whilst on a night out, participants watched a videoed theft whilst either sober or moderately (MBAC = 0.05%) or severely (MBAC = 0.14%) intoxicated. A week later, in a different location, participants were interviewed using either the Enhanced Cognitive (ECI) or Structured Interview. RESULTS: The ECI was found to improve the recall accuracy and completeness of witness accounts across all three drinking conditions. However, no significant interaction was indicated between alcohol and interview condition. CONCLUSIONS: The study findings are discussed in terms of their real-world value in aiding police officers to elicit as complete and as accurate an account as possible from intoxicated witnesses.


Assuntos
Intoxicação Alcoólica/psicologia , Cognição/fisiologia , Etanol/administração & dosagem , Entrevista Psicológica/métodos , Rememoração Mental/fisiologia , Estimulação Luminosa/métodos , Adulto , Intoxicação Alcoólica/diagnóstico , Cognição/efeitos dos fármacos , Feminino , Humanos , Masculino , Rememoração Mental/efeitos dos fármacos
4.
J Stud Alcohol Drugs ; 81(2): 212-219, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32359051

RESUMO

OBJECTIVE: The aim of this study was to compare data on both alcohol use and alcohol-related consequences between intensive longitudinal data collection and the retrospective Timeline Followback (TLFB) interview. METHOD: Heavy drinking college students (n = 96; 52% women) completed daily reports across a 28-day period to assess alcohol use and positive and negative consequences of drinking. They returned to the lab at the end of this period to complete a TLFB assessing behavior over those same 28 days. First, t tests were used to compare variables aggregated across the full 28 days at the between-person level. Next, hierarchical linear modeling was used to examine within-person differences between methods for each variable in weekly and daily increments. RESULTS: Many alcohol use and consequence variables were significantly different when derived from self-reports during TLFB versus daily reports. In contrast to prior work, we found that higher estimates of drinking were reported retrospectively on the TLFB than on the daily reports. In addition, discrepancies were greater on some variables for heavier drinkers and when more time had elapsed between the end of the daily reporting period and TLFB collection. CONCLUSIONS: Recall of drinking behavior during TLFB and daily reports may differ in systematic ways, with discrepancies varying based on participant and methodological characteristics.


Assuntos
Consumo de Álcool na Faculdade/psicologia , Coleta de Dados/normas , Rememoração Mental , Autorrelato/normas , Adolescente , Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/psicologia , Coleta de Dados/métodos , Feminino , Comportamentos Relacionados com a Saúde/fisiologia , Humanos , Estudos Longitudinais , Masculino , Rememoração Mental/fisiologia , Estudos Retrospectivos , Adulto Jovem
5.
Traffic Inj Prev ; 21(5): 295-297, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32255712

RESUMO

Objective: Auto-Brewery Syndrome is defined as the production of ethanol by microorganisms becoming dominant when inhabiting the gastrointestinal system or through the impairment of flora because of carbohydrate-rich nutrition, and the elevation of levels of measured ethanol. This study aimed to consider medicolegal approaches to individuals with Auto-Brewery Syndrome.Methods: A 38-year-old male patient who was involved in a traffic accident about two months ago and whose driving license was taken away due to his blood alcohol level measuring above the legal limits was referred to our department for the detection of any condition which might cause the elevation of blood alcohol levels without alcohol intake, in consequence of his objection submitted to the judicial authorities claiming that he had not drunk alcohol on the day of the event.Results: After the informed consent of the individual was obtained, he was admitted under supervision to an inpatient unit with a visitor ban in a manner which inhibited his intake of alcohol, and during admission his blood alcohol levels were measured at intervals. His blood alcohol level was measured as 160 mg/dl at the time of admission for monitoring and as 141 mg/dl, 322 mg/dl, 208 mg/dl and 279 mg/dl after two hours, six hours, 12 hours and 20 hours, respectively. His liver function test results were high and neurological examination was normal. The individual was diagnosed with Auto-Brewery Syndrome.Conclusion: Various gastrointestinal system abnormalities such as through laparotomy, gastrectomy are reported in most of Auto-Brewery syndrome cases. There are cases, although rare, where gastrointestinal disorders are not detected and secondary disorders of normal intestinal flora due to frequent antibiotic use seem to be a factor. Such a condition is present in the current case. Those who are aware of this condition may falsely rely on it as a method to avoid penalties. On the other hand, genuine patients suffering from this condition may be caught by traffic control and become victims of the condition. For that reason, a meticulous and planned approach should be taken to verify the condition and to ensure that it is not overlooked.


Assuntos
Acidentes de Trânsito/legislação & jurisprudência , Intoxicação Alcoólica/diagnóstico , Condução de Veículo/legislação & jurisprudência , Concentração Alcoólica no Sangue , Adulto , Intoxicação Alcoólica/metabolismo , Etanol/metabolismo , Fermentação , Humanos , Masculino , Síndrome
6.
J Stud Alcohol Drugs ; 81(1): 95-103, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32048607

RESUMO

OBJECTIVE: Social anxiety has been linked to problem drinking in young people. Identifying moderators of this relationship will aid the development of effective interventions for this at-risk group. This cross-sectional study examined whether anticipated social outcomes and controlled drinking self-efficacy moderated the relationship between social anxiety and alcohol outcomes. METHOD: A total of 385 participants (drinkers and nondrinkers; mean age = 20.98, SD = 2.35; 65% female; 81% born in Australia), completed an online survey measuring alcohol consumption, alcohol-related harms, social anxiety, anticipated social outcomes, and controlled drinking self-efficacy. Regressions examined the interactive effects of social anxiety, anticipated social outcomes, and controlled drinking self-efficacy on alcohol consumption and alcohol-related harms. RESULTS: A significant three-way interaction was found for alcohol consumption (95% CI [-0.523, -0.018]). Simple slopes revealed an inverse relationship between social anxiety and alcohol consumption when participants anticipated positive evaluations for being drunk and had high controlled drinking self-efficacy (95% CI [-1.181, -0.273]). The three-way interaction for alcohol-related harms was not significant (95% CI [-1.445, 0.799]). A significant two-way interaction revealed that the relationship between social anxiety and alcohol-related harms was only significant when individuals had low (95% CI [0.571, 3.943]), but not high (95% CI [-1.149, 0.735]), controlled drinking self-efficacy. CONCLUSIONS: Social anxiety was associated with reduced alcohol consumption when young people anticipated positive evaluations for being drunk and had high confidence to control their drinking. Further, social anxiety was associated with alcohol-related harms when young people had low confidence to control their drinking. Interventions for alcohol use among socially anxious young people could focus on increasing confidence to control drinking.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Intoxicação Alcoólica/psicologia , Ansiedade/psicologia , Cognição/fisiologia , Comportamento Social , Inquéritos e Questionários , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/epidemiologia , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Austrália/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Autoeficácia , Adulto Jovem
8.
Clin Toxicol (Phila) ; 58(3): 204-207, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31218892

RESUMO

Context: 1,4-butanediol (1,4-BD) is a gamma-hydroxybutyrate (GHB) analogue with a similarly narrow therapeutic window that is becoming a more common cause of recreational overdose. Reports of confirmed exposures are limited.Case details: A 44 year-old man who had consumed alcohol subsequently became unconscious after ingesting what was thought to be GHB. The presentation was not entirely consistent with GHB poisoning, including a longer duration of unconsciousness and features that mimicked toxic alcohol exposure including a high anion gap metabolic acidosis (HAGMA) and osmol gap. The patient was treated supportively with intubation, haemodiafiltration and intravenous ethanol until the diagnosis was refined using specific laboratory testing. The concentration of 1,4-BD was the highest reported in the literature and the outcome favourable.Discussion: This case highlights pharmacokinetic issues peculiar to 1,4-BD, including the interaction with ethanol which delays the onset of psychoactive effects from 1,4-BD's metabolite GHB, and dose-dependent pharmacokinetics. In overdose, 1,4-BD can induce a HAGMA and other features of toxic alcohol poisoning. Managing an unconscious patient with these features can prompt certain treatments until the diagnosis is refined, which can require specific laboratory testing to identify the culprit. The actual risk of toxic alcohol and other causes is adjusted on a case-by-case basis from the history of exposure and local epidemiology of substance use and poisoning.


Assuntos
Intoxicação Alcoólica/diagnóstico , Butileno Glicóis/envenenamento , Overdose de Drogas/diagnóstico , Drogas Ilícitas/envenenamento , Adulto , Intoxicação Alcoólica/patologia , Diagnóstico Diferencial , Overdose de Drogas/etiologia , Overdose de Drogas/patologia , Humanos , Masculino
9.
PLoS One ; 14(12): e0226029, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31856178

RESUMO

BACKGROUND: Intoxications with alcohol and drugs are common in the Emergency Department. This study aimed to describe the occurrence and characteristics of intoxications (alcohol, Drugs of Abuse (DOA), pharmaceutical and chemical) presented to the Emergency Department and the health care costs of these intoxications. METHODS: This was a retrospective medical record study of all patients (≥ 16 years) who presented to the Emergency Department of an inner-city academic hospital in the Netherlands due to single or multiple intoxication(s) as the primary or secondary reason in the year 2016. An intoxication was reported as present if the attending physician described the intoxication in the patient's medical record. RESULTS: A total of 783 patients were included, accounting for 3.2% of the adult Emergency Department population (age ≥ 16 year). In 30% more than one substance was used. Intoxications with alcohol, Drugs of Abuse and pharmaceuticals was reported in respectively 62%, 29% and 21% of the intoxicated patients. The mean costs per patient presenting with an intoxication to the Emergency Department was € 1,490. The mean costs per patient were highest for pharmaceutical intoxications (€ 2,980), followed by Drugs of Abuse (€ 1,140) and alcohol (€ 1,070). CONCLUSIONS: Intoxications among patients aged 16 years and older are frequently seen at the Emergency Department and are frequently caused by multiple substances. Alcohol is the most common intoxication. Substantial healthcare costs are involved. Therefore, this study suggests that further research into hazardous alcohol consumption and DOA abuse is warranted.


Assuntos
Serviço Hospitalar de Emergência/economia , Custos de Cuidados de Saúde , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/epidemiologia , Feminino , Hospitais Universitários , Humanos , Drogas Ilícitas/envenenamento , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
10.
Orv Hetil ; 160(43): 1698-1705, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31630553

RESUMO

Introduction: According to WHO data, more than 2 million people die because of alcohol consumption during one year. One part of these people are displayed in the emergency departments. There are those who are just about to be detoxicated, those who suffered alcohol-related accidents or alcohol-related internal illness. Aim: To find out how many alcohol-influencing patients are being in the emergency care system and how much of the financing are used for these patients. Method: Our research was conducted at the Department of Emergency Medicine, Clinical Centre, University of Pécs. The research period was between January 1 and December 31, 2016. Our sample was made up of patients who were exposed due to alcohol in the emergency room (n = 1326). We made document analysis. We analysed data using statistical software SPSS 22.0. Results: 78% of the patients were male. The mean age of the sample was 49.78 ± 14.215 years. 71.1% of patients had a home, but 28.9% were homeless. According to the Triage scale, 608 patients were in category T5 because they needed only detoxification. In terms of the level of consciousness, 93.7% of patients had 14 or 15 points according to the Glasgow Coma Scale. 14.6% of patients did not expect a medical examination. Within the framework of incoming and outpatient care, the provision of these patients is profitable. Conclusion: The diagnosis and care of the injuries is done in accordance with the domestic guidelines. Contrary to expectations, the care of these patients is profitable for the emergency department, although only fixed costs were included. Orv Hetil. 2019; 160(43): 1698-1705.


Assuntos
Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Doença Aguda , Adulto , Distribuição por Idade , Idoso , Intoxicação Alcoólica/terapia , Gerenciamento Clínico , Serviço Hospitalar de Emergência , Etanol , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Distribuição por Sexo
11.
J Stroke Cerebrovasc Dis ; 28(12): 104424, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31624037

RESUMO

BACKGROUND AND AIM: Alcohol intoxication can be a posterior circulation stroke mimic as they share symptoms such as dysarthria, gait disturbances and nystagmus. We describe alcohol intoxication as a stroke mimic and the frequency of acute alcohol intoxication among stroke patients. METHODS: Prospective observational single-center study (2014-2017, Haga Ziekenhuis, the Hague). In all patients older than 16 years presenting as possible acute stroke less than 6 hours of onset, blood ethanol was measured; greater than 0.1 blood alcohol concentration (BAC) was considered elevated. RESULTS: In total 974 patients were included: 60 (6%) had elevated blood ethanol (mean: 1.3 BAC). In 180 of 974 patients (18%) a stroke mimic was diagnosed: 12 were due to alcohol intoxication (1% of total cohort, 7% of stroke mimic, mean ethanol level: 2.2 BAC). Half of these patients denied or downplayed their alcohol consumption. Stroke and concurrent alcohol intoxication occurred in 38 of 794 strokes (5%, mean ethanol level: 1.1 BAC). Compared to other stroke patients, these 38 patients presented more often after working hours (mean 6.38pm versus 2.23pm) and received alteplase and endovascular therapy less often (24% versus 43%, P = .018 and 3% versus 10%, P = .241, respectively). CONCLUSIONS: Of all patients presenting as possible acute stroke, 6% also drank alcohol. 18% of the whole cohort was diagnosed with a stroke mimic. Acute alcohol intoxication as sole diagnosis was diagnosed in 1% of the total cohort and 7% of stroke mimics, 50% denied or downplayed their alcohol consumption. 5% of all stroke patients also drank alcohol, they were significantly less likely to receive alteplase or endovascular treatment.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/sangue , Intoxicação Alcoólica/sangue , Concentração Alcoólica no Sangue , Diagnóstico Diferencial , Procedimentos Endovasculares , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/terapia , Terapia Trombolítica
12.
Pediatr Emerg Care ; 35(10): 722-730, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593052

RESUMO

Ethanol intoxication of infants and young children can be a challenging diagnosis in the pediatric emergency department, and features of the poisoning may differ in comparison with adolescents. The sources of ethanol exposures in this age are varied and include unintentional, malicious, and iatrogenic etiologies. Young children exposed to ethanol often present with mixed clinical signs and symptoms that may not fit the traditional ethanol or sedative-hypnotic toxidrome. Pediatric ethanol intoxications are often managed supportively, and recovery is usually rapid. The purpose of this review is to describe the sources of ethanol poisoning among children 6 years and younger, highlight presenting symptoms and pharmacokinetic considerations unique to this age group, and review management strategies. In addition, published cases of ethanol poisoning due to ingestion among young infants are compiled for presentation.


Assuntos
Intoxicação Alcoólica/diagnóstico , Transtornos da Consciência/diagnóstico , Etanol/envenenamento , Envenenamento/psicologia , Intoxicação Alcoólica/epidemiologia , Intoxicação Alcoólica/patologia , Intoxicação Alcoólica/psicologia , Criança , Pré-Escolar , Transtornos da Consciência/etiologia , Diagnóstico Diferencial , Ingestão de Alimentos/fisiologia , Serviço Hospitalar de Emergência , Etanol/sangue , Etanol/farmacocinética , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Lactente , Recém-Nascido , Masculino , Envenenamento/epidemiologia
13.
Drug Alcohol Depend ; 205: 107603, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31605959

RESUMO

BACKGROUND: Recent research has highlighted the growing trend of alcohol preloading before a night out. We wished to look at people's motivations for preloading, their estimation for drinking during the night, and assess the impact that preloading has on how inebriated people become across the night as measured by Breath Approximated blood Alcohol Content (BrAC). METHOD: We randomly surveyed and breath-tested patrons as they entered and exited Night Time Entertainment Districts (NEDs) in Brisbane, Queensland. We obtained 360 participants who were encouraged to contact us at the end of their night, compensating them for their time with a taxi voucher. Of these, 143 people returned and completed an exit questionnaire. FINDINGS: We found that people were motivated to preload in order to save money and socialise, were likely to drink more than they predicted over the course of the night, and were more surprised by their alcohol reading the higher their BrAC; this trajectory displayed little difference between men and women. It was further found that, for men, personality contributed 19% of the variance to exit BrAC, but entry BrAC accounted for nearly 38% of unique variance. For women, body mass index significantly predicted exit BrAC (9% unique variance), but entry BrAC accounted for nearly 30% unique variance. INTERPRETATION: To reduce general levels of intoxication in city NEDs, interventions should focus on having people come in earlier, less drunk, and be taught to have more realistic appraisals of their drinking.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Intoxicação Alcoólica/psicologia , Atividades de Lazer/psicologia , Adulto , Intoxicação Alcoólica/diagnóstico , Concentração Alcoólica no Sangue , Testes Respiratórios , Cidades , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Queensland , Comportamento Social , Inquéritos e Questionários , Adulto Jovem
14.
Sud Med Ekspert ; 62(3): 37-41, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31198203

RESUMO

The aim of this study was to find additional diagnostic markers characterizing the functional state of the liver to substantiate the cause of death from ethanol poisoning. A total of 95 deaths from acute ethanol poisoning and 15 deaths from craniocerebral injury were studied. Signs of steatosis, chronic hepatitis or cirrhosis were taken into account in histological examination of the liver. The histochemical activity of ethano-locking enzymes was determined in structurally functional zones of the acini: portal pathways (Zone 1), liver beams (Zone 2) and central veins (Zone 3). Quantitative indices characterizing functional-metabolic activity of the liver during acute ethanol poisoning were obtained.


Assuntos
Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/mortalidade , Etanol/envenenamento , Fígado/anatomia & histologia , Fígado/patologia , Humanos
15.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133551

RESUMO

A 16-year-old man was brought to the emergency department by his father with apparent alcohol intoxication. While in the department, it was noted that the patient had ongoing tachycardia, hypotension and abdominal pain. His recent medical history included a self-resolving illness of fatigue, muscle aches and sore throat. A CT scan of his abdomen revealed an enlarged spleen with a splenic infarct and rupture, likely secondary to infectious mononucleosis. The patient was treated conservatively for 12 days.


Assuntos
Dor Abdominal/etiologia , Mononucleose Infecciosa/complicações , Baço/lesões , Ruptura Esplênica/etiologia , Cavidade Abdominal/diagnóstico por imagem , Cavidade Abdominal/patologia , Dor Abdominal/diagnóstico , Adolescente , Intoxicação Alcoólica/diagnóstico , Tratamento Conservador , Diagnóstico Diferencial , Humanos , Masculino , Ruptura Espontânea/complicações , Baço/patologia , Baço/virologia , Ruptura Esplênica/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Ann Emerg Med ; 74(1): 112-118, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30926186

RESUMO

STUDY OBJECTIVE: We evaluate a sobering center as an alternate destination for acute intoxication. Our aims are to count patient visits that originated from emergency medical services (EMS) or the emergency department (ED) that then result in a secondary transfer from the sobering center to the ED, and to describe and categorize the clinical reasons for transfer to the ED. METHODS: The San Francisco Sobering Center, a continuously nurse-staffed facility operating since 2003, provides short-term (6- to 8-hour) care for adults with acute alcohol intoxication. Paramedics use a county EMS protocol to triage low-risk intoxicated patients to the sobering center. A case review was performed on all visitors during 3 years who were secondarily transferred from the sobering center. Reason for transfer was categorized by clinical indication. RESULTS: From July 2013 to June 2016, 11,596 visits (from 3,268 unduplicated adults) were documented. Of these, 4,045 (35%) were referred by EMS and 1,348 (12%) were referred from the ED. Other referring parties included the mobile van service, police, homeless service provider, self-referral, and others. Of the total visitors, 506 (4.4%; 95% confidence interval 4.0% to 4.8%) were secondarily transferred to an ED; 151 were referred by EMS and 62 by the ED. Clinical indications for ED transfer included pulse greater than 100 beats/min (26%), alcohol withdrawal (19%), pain (excluding chest pain) (19%), altered mental status (13%), and emesis (13%). Most clients had more than one clinical indication for transfer (median 2; range 1 to 5). CONCLUSION: The San Francisco Sobering Center is an appropriate, safe EMS destination for patients with acute alcohol intoxication.


Assuntos
Intoxicação Alcoólica/diagnóstico , Serviços Médicos de Emergência/métodos , Transporte de Pacientes/métodos , Adulto , Delirium por Abstinência Alcoólica/diagnóstico , Intoxicação Alcoólica/epidemiologia , Pessoal Técnico de Saúde/estatística & dados numéricos , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/etiologia , Serviço Hospitalar de Emergência , Pessoas em Situação de Rua , Humanos , Encaminhamento e Consulta , Estudos Retrospectivos , São Francisco/epidemiologia , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/etiologia , Triagem/métodos , Vômito/diagnóstico , Vômito/etiologia
19.
BMC Neurol ; 19(1): 14, 2019 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-30696413

RESUMO

BACKGROUND: The signs and symptoms of acute alcohol intoxication resemble those of vertebrobasilar stroke. Due to their shared symptoms including double vision, nystagmus, dysarthria, and ataxia, the differential diagnosis of alcohol intoxication and vertebrobasilar stroke may pose a challenge. Moreover, if alcohol intoxication and stroke occur simultaneously, the signs and symptoms of stroke may be attributed to the effects of alcohol, leading to delayed stroke diagnosis and failure to perform reperfusion therapy. CASE PRESENTATIONS: Three cases of alcohol intoxication and stroke are presented. The first patient (female, 50 years old) had dysarthria, nystagmus and trunk ataxia on admission. Her blood alcohol level was 2.3‰. The symptoms improved after forced diuresis, but 5.5 h later progression was observed, and the patient developed diplopia and dysphagia in addition to her initial symptoms. Angiography showed occlusion of the basilar artery. Intraarterial thrombolysis was performed. The second patient (male, 62 years old) developed diplopia, dysarthria and trunk ataxia after consuming 4-units of alcohol, and his symptoms were attributed to alcohol intoxication. Two hours later, neurological examination revealed dysphagia and mild right-sided hemiparesis, which questioned the causal relationship between the symptoms and alcohol consumption. Cerebral CT was negative, and intravenous thrombolysis was administered. The third patient (male, 55 years old) consumed 10 units of alcohol before falling asleep. Three hours later, his relatives tried to wake him up. He was unresponsive, which was attributed to alcohol intoxication. When he woke up 8 h later, right-sided hemiparesis and aphasia were observed, and cerebral CT already revealed irreversible ischemic changes. CONCLUSIONS: Our cases show that alcohol consumption may interfere with stroke diagnosis by mimicking the signs and symptoms of vertebrobasilar stroke. Moreover, attributing the symptoms of stroke to alcohol intoxication may delay stroke diagnosis resulting in failure of reperfusion therapy. Based on our observations we conclude that stroke should be considered in the case of worsening symptoms, dysphagia, hemiparesis and disproportionately severe signs that cannot be attributed to the amount of alcohol consumed. In the case of ambiguity, ambulance should be called, and if stroke cannot be excluded, specific therapy should be administered.


Assuntos
Intoxicação Alcoólica/complicações , Intoxicação Alcoólica/diagnóstico , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/terapia , Terapia Trombolítica/métodos , Tempo para o Tratamento
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2019: 3279-3285, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31946584

RESUMO

Intoxicated driving causes 10,000 deaths annually. Smartphone sensing of user gait (walk) to identify intoxicated users in order to prevent drunk driving, have recently emerged. Such systems gather motion sensor (accelerometer and gyroscope) data from the users' smartphone as they walk and classify them using machine or deep learning. Standard Field Sobriety Tests (SFSTs) involve various types of walks designed to cause an intoxicated person to lose their balance. However, SFSTs were designed to make intoxication apparent to a trained law enforcement officer who manually proctors them. No prior work has explored which types of walk yields the most accurate results when assessed autonomously by a smartphone intoxicated gait assessment system. In this paper, we compare how accurately Long Short Term Memory (LSTM), Convolution Neural Network (CNN), Random Forest, Gradient Boosted Machines (GBM) and neural network classifiers are able to detect intoxication levels of drunk subjects who performed normal, walk-and-turn and standing on one foot SFST walks. We also compared the accuracy of intoxication detection on the ascending (increasing intoxication) vs descending (decreasing intoxication) limbs of drinking sessions (bi-phasic). We found smartphone intoxication sensing more accurate on the descending limb of the drinking episode and that intoxication detection on the normal walks of subjects were just as accurate as the SFSTs.


Assuntos
Intoxicação Alcoólica , Condução de Veículo , Transtornos Neurológicos da Marcha/induzido quimicamente , Smartphone , Intoxicação Alcoólica/diagnóstico , Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Aprendizado de Máquina
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