A DRUNKEN ADOLESCENT

The airway of any child with a GCS of 8 or less is at risk. An anaesthetist should be called urgently to monitor the airway and breathing. A blood gas may help the assessment. Most children in this setting will manage without being intubated and slowly, spontaneously recover. A cranial computed tomography (CT) scan should be done. There is very little history. Although there are no external marks of a head injury or focal neurological signs, it is possible that Laura sustained a head injury when she fell on the pavement and that this partly accounts for her low GCS. The vomiting is probably secondary to the alcohol ingestion but may be secondary to a head injury. Maintenance intravenous fluids (5 per cent dextrose/0.45 per cent saline) should be administered to help avoid the hangover headache that is primarily due to dehydration. Hourly GCS observations should be performed. Binge-drinking is very common in teenagers. It is important to try to find out the child’s name and contact their family as soon as possible. Social services should be contacted to inform them of what has happened and to find out if she is known to them. When she is awake it would be worth asking whether she takes recreational drugs and consider doing urine toxicology, if appropriate. One should also ask about the possibility of sexual abuse whilst she was drunk and unconscious. However, if there are no allegations of sexual abuse and no evidence to suggest it (e.g. missing or torn knickers) then this need not be pursued. If there are concerns about the possibility of sexual abuse, a forensic medical examiner should be contacted to do the necessary examination and to take the necessary forensic swabs. There is an association between alcohol abuse, behavioural disorders and depression. In some cases, psychiatric and/or social work input and follow-up is required.

KEY POINTS

• Binge-drinking is very common in adolescents.

• In drunken teenagers, always measure the blood glucose level.

• In children with a diminished GCS, a cranial CT should be done to rule out the possibility of a coexisting intracranial injury.

• Remember to consider the psychosocial aspects of the case.