> JM
> Thanks for that. I am sure the distinctions you mention are correct but
> feel uncomfortable to use them as criteria for discharge. The apparently
> intoxicated mild head injury is surely the patient to be watched until they
> wake up, with readiness to CT if they deteriorate instead. The patient who
> is similarly obtunded but fits the picture you give for concussion/contusion
> warrants earlier CT...is that your practice?
>
Precisely, I didnīt say anything about discharge Johnathan! I simply maintain that I canīt CT all the drunks that roll into the dept, and many have minor head injuries i.e. head lacs. To CT them all would, I believe, not simply be a logistical nightmare, but would also put some of them at unnecessary risk i.e. inducing and intubating drunks is not without risk. If I can glean something that suggests that they are simply drunk rather than obtunded from injury, then Iīd rather watch them as you and Rowley have suggested.
Adrian Fogarty
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