A pre-hospital team encounters a patient with acute alcohol intoxication who has fallen and sustained a head injury. His GCS is 10 (E2 V3 M5). His pup...

Question

A pre-hospital team encounters a patient with acute alcohol intoxication who has fallen and sustained a head injury. His GCS is 10 (E2 V3 M5). His pupils are equal at 4 mm and reactive. He smells strongly of alcohol. Blood glucose is 5.8 mmol/L. What is the critical pitfall in attributing his reduced GCS to alcohol alone?

Accepted Answer

Intracranial haemorrhage cannot be excluded by clinical examination alone in an intoxicated patient - alcohol intoxication and traumatic brain injury frequently coexist; assume the worst and manage as a head injury until imaging proves otherwise

Answer

A blood glucose above 5 mmol/L excludes all metabolic causes

Answer

Alcohol protects the brain from traumatic injury

Answer

Pupil reactivity excludes all intracranial pathology

Answer

If the patient smells of alcohol, the reduced GCS is always due to alcohol

uk-dipimc MCQ (SBA): Alcohol and Head Injury - Clinical Pitfall