Examination of case of Drunkenness ( Forensic Medicine)

Examination of case of Drunkenness

1. Examination of case of Drunkenness

2. It is a condition which results from excessive intake of alcohol to a degree that mental and physical faculties are noticeably impaired. The person under its influence shows the following : 1 . Loss of control over his mental faculties. 2. Inability to perform the duties in which he is engaged . 3 . Dangerous to himself or to others.

3. The detained person should not be examined and blood, urine or breath should not be collected without his written consent . If the person becomes unconscious or incapable of giving consent, examination and treatment can be carried out, but the doctor should not disclose any information obtained during examination and wait for his consent, till he regains consciousness. Under Sec. 53 (1) CrPC , examination of an accused can be carried out by a doctor at the request of the police, even without his consent and by use of force, if necessary. Such examination may include collection of body fluids in cases of suspected intoxication.

4. Collect Priliminary data such as: Name Age Sex Address Time of examination Two identification marks Name of person who brought the patient

5. HISTORY Enquire About Past illness Drug Treatment Nature , Quality and Time of Consumption of Alcohol Before Diagnosing the case of drunkenness, rule out conditions like Injuries (Head Injury) and other Pathological Conditions , psychological disorders which can stimulate alcoholic intoxication.

6. General appearance Manner of dressing —properly dressed or not, and soiling of clothes . Posture —whether over-erect and over smart, can stand steady or not, leans to a side or stoops forward, and can stand without support or not

7. General E xamination The scalp should be inspected and palpated for evidence of any head injury. Careful documentation of these injuries needs to be done. Specific Physical Examination Gait : It is observed for any unsteadiness, staggering, bumping into people or furniture. Orientation and memory : Ask him about incidents which have occurred few hours prior to examination to check his memory (clear, vague or confused) and mental alertness. Behavior : Whether noisy, jovial, boastful, rude, emotional, talkative, excited, nervous or uncontrollable. If the subject is cooperative, state it.

8. Face : Note his face, whether normal, flushed or pale. A lcohol is vasodilatatory, and redness of the face is indicative of this. Speech : Record whether the patient can understand, and whether his speech is normal, thick and slurred, stuttering or confused. Signs of vomiting and salivation: As soon as the alcohol reaches a concentration of about 20% in the intestines, an ileus follows which is responsible for vomiting. Nausea is responsible for abnormal salivation. Smell of alcohol: Strong, moderate, faint or none Handwriting : The person is asked to copy a few lines from a book or newspaper, and handwriting should be assessed .

9. Eyes : Examine the eyes Conjunctiva : State of conjunctiva - Normal or Congested) Pupillary size : Normal , Equal , Unequal , Mydriasis or Miosis Response to light: The person is asked to look at an object in the room while a light is shone into the eye. The reaction may be normal, delayed (intoxication), or non-reacting (severe intoxication ). Nystagmus : The head is held in the neutral position. The subject is asked to follow with the eyes of an object held about 30–40 cm in front of him/her. The object is moved from side to side to a maximum angle of about 45 °. If the object is moved to a more acute angle, the muscles of eye movement will be stressed and nystagmus can be observed. In drunkenness, drooping and swollen eyelids , congestion of conjunctiva and horizontal nystagmus may be seen, and convergence test is negative.

10. 10. Tests to determine in-coordination: These tests consist of - Romberg test Walk and Turn test One Leg Stand test Finger Nose test 11. Knee reflexes : Knee reflexes are elicited to check whether normal, exaggerated or depressed. Reflexes are equally depressed in intoxication. 12. Examine for drug abuse : Look for needle marks, shivering, yawning, rhinorrhea and lacrimation. Examine the cardiovascular system: Note pulse, blood pressure (slight rise in BP may occur), temperature and heart sounds. Respiratory (slow , shallow, deep, sighing or gasping) and Gastrointestinal system (soft, tender, bowel sounds, enlarged liver or spleen, ascites)

11. BLOOD Collection: Soap and water is used to clean the site to be venepunctured. The blood is collected from antecubital or femoral vein using a disposable syringe. Blood container should be tightly stoppered and labelled. Measurement: The BAC is the most useful measure, as there is rapid equilibration across the blood-brain barrier, therefore BAC reflects the concentration of alcohol currently affecting the brain . a– the total amount of alcohol ( in grams) absorbed in the body c – the concentration of alcohol in blood (in g/kg) p – the weight of the person (in kg) r – constant (0.68 in men and 0.5 in women) a = cpr Widmark’s Formula

12. B. Urine: Full quantity of urine passed must be collected. The patient is asked to pass urine in a toilet where there is no water source (preventing him to dilute alcohol concentration by adding water). It is collected in a large clean, sterilized, screw capped bottle. The urine is preserved, and labeled with name, date, time of taking the specimen and signature of the medical officer. Alcohol level from urine is estimated with the formula: q – concentration of alcohol in urine (in g/l) and ‘a’, ‘p’ and ‘r’ are same C. Breath: The patient is asked to blow into a rubber balloon. A breathanalyzer then analyzes the breath and estimates BAC . a= ¾ qpr

13. The report should be written at that time, and at the end the police should be informed about the doctor’s opinion. The opinion can be drafted with any one of the following statements : He/she has not consumed alcohol . He/she has consumed alcohol, but is not under the influence of it . He/she has consumed alcohol and is under its influence.

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