The Deer Hunter
When mixing whiskey and hiking leads to the ER.
By Marven Ewen, MD
In the EMS field, it is not uncommon to have to care for intoxicated patients. Alcohol is often a factor in trauma. We sort of kept an informal record of the highest alcohol level we had seen in a patient. It is remarkable when you see a patient with a blood alcohol level of 5.2 (recall the legal definition of impaired is greater than 0.8) who is still walking and talking.
In addition to the typical effects of intoxication such as ataxic gait, slurred speech, and disinhibition of behavior, alcohol can sometime mask the pain of injury. This is why we don’t clear C-spine clinically in intoxicated patients.
I once saw a hunter who had sustained an injury to his ankle when he twisted it while hiking through the woods. This occurred about a quarter mile into the woods.
Prior to going out with his friends, he had consumed a copious amount of whiskey, as was his daily routine. Fortunately, he managed not to shoot himself or his fellow hunters as alcohol and firearms are generally not a good combination.
It was winter, and he at least he had the sense to dress for the weather so he did not suffer hypothermia in spite of his high alcohol level. In addition to long underwear and a heavy parka, he was wearing a pair of insulated high-top hunting boots.
After twisting his ankle, they remained in the woods for a couple of hours, but not seeing any deer and the fact his ankle was bothersome, they decided to head back to the cabin. So he limped the quarter mile back.
After a few more drinks at the cabin, he was still complaining of his ankle, so his friends brought him to the emergency department.
So when I saw him it was approximately 5 hours since the injury. He appeared mildly intoxicated. He actually walked into the ER with partial assistance from his friend.
After the story I assumed he likely had a bad sprain. That is, until I took off his boots. His right ankle was very swollen, ecchymotic, and unstable. Fortunately for him, CMS was intact to his toes. His X-ray showed a Trimalleolar fracture.
This is a combination of three fractures of the bony prominences of the ankle: the lateral malleolus, medial malleolus, and posterior distal tibia.
When this happens, ligaments also usually get disrupted and the joint is unstable. It’s time to call an orthopedic surgeon. It is amazing that he had been walking on this, but the boot acted as a pseudo splint and the alcohol numbed the pain.
This story is an example that alcohol is often associated with injuries, alcohol can mask the pain of an injury, and some people can be more impaired than they appear. Also, if you go on a long hike in the woods, wear sturdy boots.
More from The Allied Times
Early Indicators of Thyroid Problems Identifying early signs and symptoms of thyroid disorders.By Mariah Xzena Briones, RMTCertification SpecialistHormones control our bodily functions—body temperature, menstrual cycle, regulation of metabolism, muscle strength and more. A balance of hormones is necessary for regular function. Any variation from the optimal balance can result in health issues – the thyroid…
An Unusual Cause of Dyspnea The reasons behind difficulty breathing can be surprising.By Marven Ewen, MDMedical DirectorA stoic 73-year-old man was brought to the ED with dyspnea. He had a history of COPD and was administered albuterol en route to the hospital with no change in dyspnea. I noticed his shoes were not tied.…
Raynaud’s PhenomenonThe vascular condition where cold fingers and toes aren’t just from winter weather.By Jenny Ewen, BA, NREMTEditor-In-ChiefOverviewAs the winter season settles upon us, feeling cold is a pretty common occurrence. Blood vessels near the surface of the skin will constrict when exposed to cold in order to push blood deeper in the body and…
Stress Eating: An Emotional Blackhole Stress and overeating can go hand in hand, but prevention is possible.By Mariah Xzena Briones, RMTCertification SpecialistAre your cravings immensely increasing when you’re bombarded with never-ending tasks at work? Have you noticed your study table being more occupied with snacks than books especially during exam week? Food cravings and increased…
A Trip to Africa The threat of malaria must be considered when traveling.By Marven Ewen, MDMedical DirectorOne evening an aspiring 40 year old nature photographer was brought to the ER. He was feeling ill with intermittent fever for several days. He had malaise, arthralgias, a headache, and episodes of delirium. No one else in the…
Carpal Tunnel Syndrome Early diagnosis is key to stopping progression of this condition.By Mariah Xzena Briones, RMTCertification SpecialistEMTs must use their hands and wrist to carry patients or move heavy objects for rescue operations. When the patient is critical for both time and condition, EMTs prioritize their patients and sometimes overuse their hands and wrists…