Alcohol: What an Emergency Room Actually Sees

Call 911 if someone who has been drinking is unresponsive, breathing slowly or
irregularly, cold and clammy, blue or grey around the lips, having a seizure, or
vomiting while not fully awake.

Do not let them sleep it off. Alcohol keeps being absorbed after the last
drink, so someone who seems merely very drunk can get worse while asleep — and
the danger is choking on vomit or simply stopping breathing.

If they are breathing and you cannot rouse them properly, roll them onto their
side, head tilted slightly back, and stay with them. Then call 911.

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What we actually see, which is not what people expect

Very little of it is the stereotype. The commonest alcohol-related
presentations here are injuries — falls, a head strike, a wrist broken putting
a hand out, a cut from broken glass, a crash. Alcohol is usually the reason the
injury happened rather than the reason someone came in.

Then, in rough order:

• Head injuries, which are the ones that worry us most. Alcohol masks the
  symptoms of a bleed and makes the examination harder, so a head strike with
  alcohol involved has a lower threshold for a scan, not a higher one.
• Alcohol poisoning, usually in someone young, usually after spirits drunk
  fast.
• Withdrawal, which is dangerous and is covered below.
• Vomiting blood, or black stools — a bleed in the stomach or gullet, which
  is an emergency.
• Severe upper abdominal pain going into the back — the pancreas, and it is
  a genuine emergency rather than a bad hangover.
• Heat illness and dehydration, which in this valley is the interaction that
  catches people out. See below.

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The Arizona interaction nobody plans for

Alcohol and heat are a considerably worse combination here than the same
drinks anywhere cooler, and the reasons stack:

• Alcohol makes you lose fluid at a time when you are already losing it
  faster than you think.
• It interferes with how the body sheds heat, and it blunts the thirst that
  would normally correct the problem.
• It removes the judgement that would tell you to get out of the sun, stop
  the hike, or leave the pool.
• You feel cooler than you are, which is the dangerous part.

A day by the pool with drinks is one of the more common routes to a summer
emergency visit, and it rarely feels like a risky afternoon while it is
happening. Hiking with a hangover is worse again — you start the day already
depleted.

Heat illness ·
Dehydration

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Withdrawal is the part most people do not know is dangerous

If someone drinks heavily every day, stopping abruptly and alone can be
life-threatening. Not unpleasant — dangerous. This is the opposite of what
most people assume, and it is the most useful thing on this page.

Signs that withdrawal is becoming serious, usually 6 to 72 hours after the
last drink:

• Shaking, sweating, a racing heart
• Agitation, confusion, or not knowing where they are
• Seeing, hearing or feeling things that are not there
• A seizure
• Vomiting that prevents keeping fluids down

Any of those is a 911 call or a visit today. A seizure from withdrawal can
be the first sign rather than the last.

So: if you or someone you know wants to stop drinking and has been drinking
heavily and daily, that is worth doing with medical help rather than alone. It
is a safe and ordinary thing to ask for, and it is far easier to arrange before
day two than during it.

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Driving, said once and plainly

You cannot judge your own fitness to drive after drinking, because the thing
that judges it is the thing affected. That is the entire problem, and it is
why "I felt fine" appears in so many crash accounts.

Put the keys somewhere else before the first drink, not after the third.
Decide the way home while you are still the person who makes good decisions.

And the morning counts. Alcohol clears at a fixed rate that nothing speeds
up — not coffee, not a shower, not a big breakfast. If you drank late, you may
still be over the limit in the morning, and we see the crashes that come from
that as well as the night ones.

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What happens when you arrive here

• A physician sees you — board-certified, every visit, at every hour.
• Assessment for injury first, because alcohol hides injuries and a head
  strike is the thing most easily missed.
• CT and X-ray on site, which matters here specifically: alcohol lowers the
  threshold for scanning a head injury rather than raising it.
• Laboratory work in the building.
• A critical care room here for the presentations that need one.
• Monitoring for up to 24 hours, which in this presentation is often the
  treatment — someone who needs watching while alcohol clears, or while
  withdrawal is managed, rather than admitting.

If admission or hospital-level inpatient care is needed, we stabilise and
arrange the transfer. We are an emergency room, not a hospital.

Nobody will be lectured. Tell us honestly what and how much — it changes
what we look for, particularly around withdrawal timing and head injury, and it
is the single most useful thing you can give us.

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If you want help with drinking

• SAMHSA National Helpline — 1-800-662-4357. Free, confidential, 24/7,
  refers to local services.
• Ask us before you leave. It is a normal request and easier to arrange
  while you are here.
• If you are drinking heavily and daily, do not stop on your own. See above.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Walk in. No appointment, no referral.
If this is a medical emergency, call 911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history, your medications, or what is happening to you
now. If you are unsure, call us or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• MedlinePlus (National Library of Medicine) — Alcohol — https://medlineplus.gov/alcohol.html
• MedlinePlus Medical Encyclopedia — Vomiting blood — https://medlineplus.gov/ency/article/003118.htm

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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