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It shouldn't be that hard if you really hold them until they are no longer intoxicated. The last time I had a mTBI was actually in a hospital, luckily enough (p

It shouldn't be that hard if you really hold them until they are no longer intoxicated. The last time I had a mTBI was actually in a hospital, luckily enough (passed out from standing up after traction). All the standard tests, i.e. follow this pen with your eyes, stand up straight and touch something, were things I continued not being able to do well for weeks. Alcohol impairment goes away after a few hours. Granted, they obviously get more mild than that, but the milder they are, the less they matter as long as it isn't happening repeatedly.

n8henrie 3y ago
> Alcohol impairment goes away after a few hours. I think this is a gross oversimplification. If memory serves, the rate of ethanol metabolism is something around 0.015 (units?) per hour. In my ED, an average BAL for a patient that we realize is intoxicated (and choose to get a level) is probably 0.3 or so. 0.4 - 0.5 is common, and we see nearly 0.8 (in ambulatory patients!) from time to time. So for 0.3, if you are maximally generous and consider "sober" 0.08 (the level for an automatic DUI in my state), you're looking at 15 hours of observation. Not exactly "a few." Further, your own anecdote highlights exactly my point. How you you *know* you had a TBI? Because it felt like one? Because a doctor told you it was one? Because a physician's (subjective) assessment of your exam suggested it was one? Because your insurance would cover an inpatient stay for one if they listed that as the diagnosis? Don't misunderstand, I do a relatively thorough neurological exam compared to my colleagues, but I have no pretenses as to the level of subjectivity in my assessment, or to the external biases that could potentially sway my judgment. A more objective measure would be greatly appreciated, both to help ensure that I was acting in patients' best interest, and frankly to help me compel others to act in appropriate cases.

n8henrie 3y ago

> Alcohol impairment goes away after a few hours. I think this is a gross oversimplification. If memory serves, the rate of ethanol metabolism is something around 0.015 (units?) per hour. In my ED, an average BAL for a patient that we realize is intoxicated (and choose to get a level) is probably 0.3 or so. 0.4 - 0.5 is common, and we see nearly 0.8 (in ambulatory patients!) from time to time. So for 0.3, if you are maximally generous and consider "sober" 0.08 (the level for an automatic DUI in my state), you're looking at 15 hours of observation. Not exactly "a few." Further, your own anecdote highlights exactly my point. How you you *know* you had a TBI? Because it felt like one? Because a doctor told you it was one? Because a physician's (subjective) assessment of your exam suggested it was one? Because your insurance would cover an inpatient stay for one if they listed that as the diagnosis? Don't misunderstand, I do a relatively thorough neurological exam compared to my colleagues, but I have no pretenses as to the level of subjectivity in my assessment, or to the external biases that could potentially sway my judgment. A more objective measure would be greatly appreciated, both to help ensure that I was acting in patients' best interest, and frankly to help me compel others to act in appropriate cases.