Frequently asked questions from doctors include;
• Whether the examined person had consumed alcohol?
• If he had consumed alcohol, whether he is under its Influence.
Definition:
Drunkenness is a condition produced in a person who has taken alcohol in a quantity sufficient to cause him to lose control of his faculties to such an extent that he's unfit to execute the occupation in which he's engaged at the material time.
Examination
Aims of examination compromises
• Whether the person consumed alcohol or not?
• If he had consumed alcohol, whether he is under its influence or not?
• Whether the state is due to alcohol intoxication or some other natural illness or due to other intoxication or head injury?
• Whether it is safe for him to be detained in police custody or he should be admitted to the hospital for treatment?
Consent:
Like others, examination consent should be obtained from the person before proceeding with the examination.
If a person is too drunk or otherwise unconscious, so no consent could be obtained, then the doctor should be examined possible but the result of his examination should not be given to police until retrospective consent has been obtained from the person when he has recovered completely. However, if the person had been arrested for a criminal offense and is under the custody of the police, then the medical practitioner can proceed with the examination of the accused without his consent.
Preliminary particulars:
Preliminary particulars such as name, age, gender, address, identification marks, time and date of medical examination, name of accompanying person, and brief history should be recorded.
Physical examination
1. General appearance — state of clothing (whether soiled by vomit us or feces), behavior, disposition.
2. Record vital data such as — temperature, pulse, respiratory rate, and blood pressure. In alcohol intoxication, there is tachycardia and vasodilation of cutaneous vessels that results in warm and flushed skin. The Respiratory rate is increased. Low doses of alcohol cause a mild drop in blood pressure, but more consumption results in a dose-dependent increase in blood pressure.
3. Speech — normal, thick, slurred, or over-precise.
Speech production is a complex motor activity that requires coordination and is considered a sensitive index of alcohol intoxication. Slight distortion of certain consonants is one of the early signs of incoordination of muscles of the tongue and lips. Certain test expressions may be used to bring out this difficulty in a speech, similar to “British constitution”, “truly pastoral” etc. A sober person may say that he's not good at similar expressions; the crapulous person frequently embarks to get them rightly.
4. Breath — the smell of alcohol present or absent. The converner present in alcoholic beverages impart a peculiar odor that could be appreciated in the breath of a drunken person.
However, certain other preparations may also impart such odor, and the substances are given below,
Ayurvedic preparation -contains alcohol up to 14 percent.
Wincarnis — (British tonic wine) contains alcohol up to 20 percent.
5. Stance — does he stand properly or sway when standing erect with his feet together and eyes closed?
A drunken person sways while doing such exercise.
This is a – positive Romberg sign. (In Romberg’s test, the person is asked to stand with his feet closely approximated, first with his eyes open and then with his eyes closed.
6. Gait — observe whether the gait is normal or staggering.
A drunken person has a staggering gate. The person is asked to walk in a straight line. His gait should be observed. While walking straight, the person is asked suddenly to turn to judge the reaction time. A drunken person will take more time for turning and takes one or two steps before turning.
7. Writing — the person should be asked to write a few lines in a language familiar to him. Note the time taken to write, repetition or omission of words, and ability to read his handwriting. The drunken person often takes more time to copy a sentence and may have difficulty in writing the letters N, M, or W. Often; he omits or repeats some words or alphabets.
8. Eyes — note the state of the conjunctiva, pupillary size, and reflex, visual acuity, and presence or absence of nystagmus.
In a drunken person:
• Conjunctivas are congested
• The pupils — in the early stages, it is stated that pupils are dilated and as the level of intoxication advances, especially in a coma, it becomes pinpoint.
• Pupillary reflex — the pupillary response to light is delayed or sluggish in a drunken person.
• Convergence — in this test, the extrinsic muscles of the eye are being tested. The person is asked to follow the finger of the medical examiner in all normal directions and then ask to converge the eyes on a near object.
• Nystagmus — nystagmus is noted in alcohol intoxication.
The presence of fine lateral nystagmus (alcohol gaze nystagmus AGN) indicates alcohol intoxication.
Due to reduced visual acuity a dilated pupils, a drunken person stares and tries to steady his gaze leading to alcoholic gaze nystagmus.
9. Reflexes — in a drunken person, knee and ankle reflexes are sluggish or delayed. Planter reflexes may be extensor or flexor.
10. Muscular coordination — following are some tests used to determine muscle coordination.
• A-Finger nose test —where the person is asked to touch the nose by his index finger alternately with each upper limb.
• B-Finger to-finger test.
• C-Unbuttoning and buttoning the shirt.
• D-Picking objects from the floor.
Systemic examination
• CNS — examination is carried out to access:
• Memory — test the ability for recent memory, Orientation to time and place.
• Other systemic examinations should be done in the usual way.
• Note presence or absence of injuries or any pathological condition resembling alcohol intoxication
Collection and preservation of samples:
Blood — while collecting a blood sample, the spirit should not be used to cleanse the surface rather the surface should be washed with soap and water. Five ml blood samples should be collected in a screw-capped bottle of universal size. The cap should be properly secured after adding the appropriate preservative. Five mg of sodium fluoride (acting as an enzyme inhibitor) and 15 mg of potassium oxalate (acting as an anticoagulant) for 5 ml of blood.
Urine — for proper analysis, two samples of urine are required.
The first sample should be collected after 20 to 30 minutes later second sample should be collected.
The concentration of alcohol in the second sample reflects the blood alcohol during the inter-specimen interval.
The difference in the alcohol concentrations in the two samples indicates whether the person was in the absorptive phase, at its peak, or in the elimination phase.
Opinion:
After examination of the person, the medical examiner should furnish an opinion in one of the following ways:
• The individual has not consumed alcohol.
• The examined individual has consumed alcohol, but he is not under its influence.
• The examined individual has consumed alcohol, and he is under its influence
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