Can I get a drink?

It is not uncommon to see chronic drinkers end up on the trauma service. When it comes to trauma, it seems just about anything goes. "Fall" or "found down" are common catch-all types of trauma we see, when in fact there may be no trauma. My favorite was "found down in bed." Hum...most of us are. At least I am; every morning in fact. Anyways, the fall or found down group will often bring in a drunk. And generally, if they do have a "traumatic injury," it tends to be abrasions, lacerations, contusions, and hematomas/cephalohematomas. Not all, of course, but more often than not. So clearly the plan would be to clear their cervical spine, i.e. get the neck collar off of them once the radiology read is back and negative, and then discharge home, or street.

That plan can be delayed if they are still drunk because they can't answer your questions, because they can't walk straight yet, or because they just won't wake up enough to leave. But then, if they drink a lot, you only have a window to get them out once coherent enough to talk, walk, and eat. If they actually had injuries, you tend you run into problems. This is because caring for the injury tends to take longer than that special coherent window. Even if caring for their injuries was essentially consulting another service (say Plastic surgery for a nasal fracture), and they say the patient is non-op and ok to dc, but it took until the following day to get that answer, then you may have missed the window. Then ensues the withdrawal, and what would have been a short hospitalization turns out to be longer than a week, sometimes requiring them to go to the ICU for management of severe withdrawal.

One thing we do at our hospital that some people seem surprised by is that we give chronic drinkers beers with meals in the hospital. This is with the thought they can be discharged soon and they will go back out to drink again. In order to stave off the DTs, and in turn avoid a long hospitalization, we give them beer. Ativan is always made available prn, too. If they have significant injuries and will be in the hospital a while, that tends to change management. Generally then the choice is to go with a Librium taper. But we rarely start a Librium taper on an overnight drunk with minor abrasions. I do think it is a bit sad that they don't get intervention. It is, however, true that most of them go straight from the hospital to go look for a drink. They'll even tell you that's their plan. So in those cases I suppose beers with meals is a proper plan. But I think it would be nice if we also had a routine of offering our drunks the option of a Librium taper prescription if they'd like to kick the habit. But now you know, some hospitals do indeed give patients alcohol.