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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Elizabeth on March 30, 2001, at 6:20:36
Hi everyone. I was recently in the hospital (medical, not psych) for 3 weeks, having been found by my boyfriend breathing extremely rapidly, pale, my pulse weak and rapid, shaking, my jaw clenched shut, my eyes rolled back, my skin cold, and completely unresponsive to anything including pain. He says that I was in shock (he knows a little about this sort of stuff). He called 911, and a mob of paramedics descended on his house. They took me to a small community hospital because it was the closest one to his house.
When I got to the hospital, they became convinced I had OD'd on benzos because I tested positive for them. My boyfriend pointed out to them that the paramedics had given me Ativan at the scene (as I said, my jaw was clenched, and they needed to get an oxygen tube into my mouth), but they refused to send a blood sample off to a lab to get a comprehensive quantitative tox screen. They continued to go with their original assumption, even though all the evidence suggested otherwise. (My boyfriend and parents looked through my medications; all of them were there, including the benzos. There was no way I'd OD'd on my meds, period. Anyway, none of the signs I presented with is at all typical of benzo overdose.)
Because they were insisting that I'd overdosed, they refused to sedate me. As a result, I pulled out my breathing tube because it was causing me pain (which they also were refusing to medicate -- my mother, who is a biomedical ethicist and knows this sort of thing, tells me that they probably committed malpractise). They tried to get me breathing through an oxygen mask, but that still wasn't getting me enough oxygen, and I was hyperventilating like crazy (100/min). So they had to intubate again. (At this point they found a bed at the big teaching hospital which was about 45 minutes away and started trying to get things moving to get me transferred.) This time they followed correct procedure and sedated me. I'd been at the community hospital for three days when I was (finally!) transferred to the large teaching hospital and admitted to the MICU there.
My parents and boyfriend report that this ICU was extremely well-run, in contrast to the previous one. They had me on like 5 different infusion pumps plus the ventilator. It would have been scary if I'd been conscious. (The few times I was conscious, I was confused and disoriented, to say the least. My boyfriend says that he thought I seemed terrified and was crying and stuff. Glad I don't remember any of it.)
After a few days (I'm not clear what exactly they did except a lot of diagnostic tests and supportive therapy), they felt I was ready to breathe on my own, and they took out the tube. (I was awake at this point, and it didn't hurt but it felt really weird and looked even weirder.) They had me breathe through a nasal cannula, which is a bit uncomfortable but far less...invasive! Anyway, things proceeded, eventually I was able to breathe, drink, and eat on my own, and my pulse ox, blood gases, blood pH, vital signs, etc. were all okay, and they decided to move me to a regular medical unit. When they first moved me, I was in this room on the 7th floor and it was the middle of the night. A couple hours after I got there, I started having a lot of the same signs that had been present when my BF found me...tachypnea, eyes rolled back, jaw clenched, shaking, sweating, alternately feeling cold and hot. The only difference was I wasn't comatose -- I was completely conscious and aware of what was happening to me (and boy, it sucked). I have no idea what caused this to happen again, maybe the stress of being moved? Who knows. (It's not even clear what caused it to happen in the first place; the doctors' theory is that I had a seizure (more on that later), vomited, and aspirated some of the vomit -- my chest x-rays were way screwed-up, even when they decided to move me.)
So then they moved me again, this time to the neuroscience unit. First I had a 24-hour EEG. It showed nothing of interest. Then I had an MRI (my third since 1997). Perfectly normal. After that they sent me for a SPECT scan. This, they tell me, was glaringly abnormal (I'm not clear in what way it was abnormal, or what the abnormality indicated; they did say that it was pretty generalised but was more pronounced in the limbic system, especially the thalamus). The neuro team said they thought that it indicated that I might have temporal lobe epilepsy; the psych team felt it might explain my problems responding fully to standard antidepressant treatments. When all you have is a hammer, everything looks like a nail, right? < g >
So after that, I went home. The only loose end to tie up (other than getting the SPECT results clarified and possibly being treated for epilepsy -- I have an appointment with a specialist on seizure disorders on 2 April) was that my platelets were high. The hematology fellow told me to make sure I got plenty of fluids and put me on aspirin and iron supplements. (Thank god, no more of those subcutaneous heparin shots -- ouch!)
Did I mention that they took me off all antidepressants? I can understand this when I was still in the ICU, but after that? Nothing. Barbaric. Anyway, the psych people said to go ahead and go back on the Parnate and bupe, so I did and I'm doing better now. But god, some of that time after I woke up in the hospital was hell.
Anyway, just wanted to fill you in and see if anybody has any ideas or opinions or at least enjoys a good story with a happy ending. It's good to be back.
Posted by stjames on March 30, 2001, at 13:14:50
In reply to epilepsy?! (long, some ranting), posted by Elizabeth on March 30, 2001, at 6:20:36
> Did I mention that they took me off all antidepressants? I can understand this when I was still in the ICU, but after that? Nothing. Barbaric. Anyway, the psych people said to go ahead and go back on the Parnate and bupe, so I did and I'm doing better now. But god, some of that time after I woke up in the hospital was hell.
James here....
Some AD's lower the convulsive threshhold,the point at which one starts to seize, this many have been their reasoning. You would want to make sure this is not the case with Parnate. What is bupe ?
James
Posted by Michele on March 30, 2001, at 19:51:10
In reply to epilepsy?! (long, some ranting), posted by Elizabeth on March 30, 2001, at 6:20:36
My god girl, after reading your story, I was just "wowed". I'm glad your feeling better... and continue to do so. My thoughts are with you!
Posted by Eric on March 30, 2001, at 20:06:07
In reply to epilepsy?! (long, some ranting), posted by Elizabeth on March 30, 2001, at 6:20:36
Hi Elizabeth, sorry to hear of your travails. When shit hits the fan, sometimes it really hits the fan. When it rains it pours. I feel bad that they just assumed you ODed on benzos and treated you like that. One bit of advice for you, even though I realize you wont take it. Try to get off the opiate stuff if you can.
Wouldnt it be neat to know that your depression problems perhaps have an underlying cause or exacerbating factor like epilepsy? That the doctors can actually detect with tests? Least then youd know why youve had so much difficulty.
Hey...maybe if they diagnose you with epilepsy you could just have one of those VNS implants put into you? There was an article here in the local paper about six months ago about a man who had problems with epilepsy and severe depression. The depression seemed to somehow be related to the chronic seizures and epilepsy. Sooooooooo they just put a VNS implant in him and according to the article his epilepsy AND depression was then under control. It was in the High Point Enterprise about six months or so ago, I still remember the article.
If it turns out you have epilepsy you dont have to get accepted into a VNS clinical trial to have one implanted into you...hint hint. Kill two birds with one stone with a VNS implant?
take care,
Eric
Posted by Elizabeth on March 30, 2001, at 20:19:48
In reply to Re: epilepsy?! (long, some ranting), posted by stjames on March 30, 2001, at 13:14:50
> > Did I mention that they took me off all antidepressants? I can understand this when I was still in the ICU, but after that? Nothing. Barbaric. Anyway, the psych people said to go ahead and go back on the Parnate and bupe, so I did and I'm doing better now. But god, some of that time after I woke up in the hospital was hell.
>
> James here....
>
> Some AD's lower the convulsive threshhold,the point at which one starts to seize, this many have been their reasoning. You would want to make sure this is not the case with Parnate. What is bupe ?Parnate is not proconvulsant. Bupe is buprenorphine, an opioid mixed agonist-antagonist.
They were giving me morphine for a while, but I was sedated with a whole bunch of other stuff at the time so it didn't come in particularly handy as an AD.
Posted by Dr. Bob on March 31, 2001, at 1:49:01
In reply to epilepsy?! (long, some ranting), posted by Elizabeth on March 30, 2001, at 6:20:36
> It's good to be back.
And to have you back. :-)
Bob
Posted by SLS on March 31, 2001, at 11:21:19
In reply to Re: epilepsy?! (long, some ranting), posted by Elizabeth on March 30, 2001, at 20:19:48
Hi Elizabeth.
A few months ago, a friend of mine suffered a series of seizures, including what appeared to be a grand-mal - convulsions and foaming at the mouth among other things. The others seemed more like absence. She lost periods of time and displayed strange behaviors. She thought that the latter episodes were psychotic manifestations of the schizoaffective disorder she has been diagnosed as having. I can't remember all of the medication she was on, but I know she was taking 1.5mg of Risperdal and Cogentin, and Neurontin. None of these had been changed for at least six months prior to these episodes, and she remained completely free of mood or schizoid symptoms.
The one confounding variable is that she had taken Xanax regularly. Her doctor wanted to reduce her dosage in half and eventually discontinue it all together. When these episodes occurred, I think she was taking the lower daily dosage of Xanax. I will ask her the next time I see her. The night prior to the first grand-mal seizure, she had a loud and angry argument with her boss at worked and walked out having quit. This was undoubtedly a very stressful event, and I guess it could have played a significant role in the precipitation of the seizure. She has also been under serious financial stress more recently. I am not sure which is worse, bankruptcy or organic chemistry.
When she was hospitalized for neurological tests, they found nothing and could not account for the episodes. There was no mention of the potential for Xanax withdrawal to have been contributary, even though all of her medical records had been forwarded to the neurological department. As quickly as these episodes appeared, they disappeared.
Her reduction in the dosage of Xanax by half left her taking it once a day rather than twice a day. Knowing its short half-life, does this change in Xanax dosing reflect any changes you may have made in your dosing of buprenorphine or any anxiolytic drugs you might be taking? If so, do you think an increase in academic stresses could have played a part?
Just a few thoughts without any particular suspicion...
- Scott
Posted by medlib on March 31, 2001, at 17:36:43
In reply to epilepsy?! (long, some ranting), posted by Elizabeth on March 30, 2001, at 6:20:36
Elizabeth--
What a truly horrific nightmare! Missing a good part of it sounds like a real blessing. I have a vague memory (but, lately, *all* my memories are vague) of an earlier Babbler with your handle who was a TRD with a specialized knowledge base, but I can't remember exactly what kind--chem, bio, ? Are you she?
The description of your "episodes" sounds like an autonomic system freak-out, er, overactivity--which would be consistent with a SPECT scan showing hyperactivation of deep brain structures. My son has had epilepsy for over 20 years without ever having an abnormal EEG or MRI. For some, the brain's abnormal electrical propagation (that causes a seizure) never reaches the surface and is not associated with a structural lesion or defect. In those cases, the only way *any* difference can be detected is with a process-type scan like a PET (the best--especially the new hi-res ones, but very expensive and still in limited locations) or a SPECT. The latter can be done in an exercise mode, useful because that can be a seizure trigger for some.
Your 2nd episode, if termed a seizure, would be labeled a "partial, simple." How's that for misnomer-of-the-month? Do you happen to remember any unusual sensory experiences during it (like weird smells, sounds louder, softer or different, vision blurred, etc.)? Did you have any warning, any premonition or vague feeling of uneasiness before it began? I realize that terror is a terrific memory eraser, tho.
What's puzzling is that adult-onset epilepsy seldom just appears out-of-the-blue. It usually has a discernible trigger--post-MVA or other head trauma, neuro damage from alcoholism or other substance abuse, *something*. (A one-time seizure can be caused by a drug reaction or very high fever, but that isn't termed "epilepsy.") Your symptoms also could be consistent with severe Seratonin Syndrome or MAOI-induced toxic shock, as well; but, I can't see you knowingly coming in contact with an MAOI no-no, and your meds aren't seratonin-mediated. Very strange!
Re Monday: I'd almost be willing to bet that they'll be unable to elicit prodromal symptoms with their flashing lights, repetitive noises, etc. (if, in fact, they bother with those tests anymore). Have you ever taken an anti-convulsant med for depression? I think that the therapeutic blood level for seizure control is higher than for depression relief (esp. since the AC is most often an adjunctive med)--but I'm not sure. I don't know of an AC that isn't sedating at therapeutic levels--they're all CNS depressants--but, Depakote is less so than some, I believe. If they put you on an AC, they might have to DC your current meds. Parnate, being a CNS activator, could interfere with the desired effect of some ACs and is contraindicated with others (Tegretol). Don't know about bupe (might it have an additive, if not potentiating effect with ACs?).
What a hassle--as if having plain old TRD weren't more than enough! Glad you survived your hospital experience (that's much more difficult than it used to be). Hope you find an atypical neurologist (not the usual cold fish who speaks condescendingly, answers no questions, and resents your asking them). Please, take care and do let us know what happens.
With fingers crossed---medlib
Posted by Adam on March 31, 2001, at 21:33:02
In reply to epilepsy?! (long, some ranting), posted by Elizabeth on March 30, 2001, at 6:20:36
I dated someone for years who had TLE. She never had an experience like that. I was present during a number her episodes, but never witness what I would normally think of as a clonic attack (she suffered from both simple and complex partial seizures). She HAD had a pair of grand mal seizures in her early teens, but this was due to the growth of a benign glioma, which was removed. The scarring from that operation was the likely source of the delayed sequelae. At any rate, she was diagnosed and treated (with carbamazapine + clonazapam, plus some psychotherapy, FWIWW) at around age 20, and suffered far fewer problems on the medications.
As I said, her seizures bore little or no resemblance to what you have described. They were frightening, to be sure, but rarely lasted for more than a few minutes, and most certainly did not leave her in need of a respirator or anything of the sort. The most common symptoms were feelings of intense dread, a sense of a malevolent presence in the room or nearby, sometimes odd or acrid smells, auras, and, if the episode was particularly serious, a kind of catatonia. Her head would loll a little, and she would stare vacantly, maybe moving her tongue and mouth in a strange manner...but it always passed quickly, and fortunately, without any clear lasting effect. At night, while asleep, she would sometimes make violent movements and repeatedly gnash her teeth together in a way that was clearly audible, but whether or not this was just normal nocturnal myoclonus or related to her illness I do not know.
We both read a lot about TLE. Whatever happened to you, it sure doesn't sound like TLE to me. And besides, if the abnormality is most pronounced in the region of the thalamus, why are they talking about the temporal lobe?
I think complex seizures are, well, complex, and so is the diagnosis. I do not want to cast doubt on your physicians, but I hope you get a second oppinion as a matter of principle. I seem to remember my ex was diagnosed by a guy at Beth Israel (?), but it was so long ago I can't remember the name. Perhaps I can look it up a list of MDs and jog my memory.
Best of luck.
Posted by Adam on March 31, 2001, at 22:06:30
In reply to TLE » Elizabeth, posted by Adam on March 31, 2001, at 21:33:02
Hmm. Now that I think about it, I seem to remember something about changes in the brain that could be manifested in other regions besided the temporal lobe. The hippocampus, I think, was a common site of lesion of one form or another (and hence a clear physiologic indicator of already noticible problems with memory that can plague TLE and other epilepsy sufferers), but I think, if I remember correctly, that this was thought to be more an affect than a cause of the epilepsy, and usually became pronounced only after years of frequent and prolonged ictal activity. I want to say mesenchymal-TLE (which would be absurd). Maybe meso-TLE? I think, as I said, extended periods (on the order of years or decades) of uncontrolled or poorly controlled seizures certainly could be a cause of changes in brain morphology. But do you think you may have been suffering from seizures for a long time? I seem to remember you mentioning once something about anxiety attacks that had precursor auras. Now I have to wonder...
> I dated someone for years who had TLE. She never had an experience like that. I was present during a number her episodes, but never witness what I would normally think of as a clonic attack (she suffered from both simple and complex partial seizures). She HAD had a pair of grand mal seizures in her early teens, but this was due to the growth of a benign glioma, which was removed. The scarring from that operation was the likely source of the delayed sequelae. At any rate, she was diagnosed and treated (with carbamazapine + clonazapam, plus some psychotherapy, FWIWW) at around age 20, and suffered far fewer problems on the medications.
>
> As I said, her seizures bore little or no resemblance to what you have described. They were frightening, to be sure, but rarely lasted for more than a few minutes, and most certainly did not leave her in need of a respirator or anything of the sort. The most common symptoms were feelings of intense dread, a sense of a malevolent presence in the room or nearby, sometimes odd or acrid smells, auras, and, if the episode was particularly serious, a kind of catatonia. Her head would loll a little, and she would stare vacantly, maybe moving her tongue and mouth in a strange manner...but it always passed quickly, and fortunately, without any clear lasting effect. At night, while asleep, she would sometimes make violent movements and repeatedly gnash her teeth together in a way that was clearly audible, but whether or not this was just normal nocturnal myoclonus or related to her illness I do not know.
>
> We both read a lot about TLE. Whatever happened to you, it sure doesn't sound like TLE to me. And besides, if the abnormality is most pronounced in the region of the thalamus, why are they talking about the temporal lobe?
>
> I think complex seizures are, well, complex, and so is the diagnosis. I do not want to cast doubt on your physicians, but I hope you get a second oppinion as a matter of principle. I seem to remember my ex was diagnosed by a guy at Beth Israel (?), but it was so long ago I can't remember the name. Perhaps I can look it up a list of MDs and jog my memory.
>
> Best of luck.
Posted by SLS on April 1, 2001, at 12:26:44
In reply to Re: epilepsy?! (long, some ranting), posted by SLS on March 31, 2001, at 11:21:19
Elizabeth.
I spoke to my friend last night about her series of seizures.
She made absolutely no changes in her medication regimen, including Xanax. She continued to take the same amount of Xanax using a twice a day schedule. She had not been told by her doctor to reduce the dosage yet.
She was taking Risperdal, Neurontin, and Xanax.
The only variables that I can think of is the recent significant increase in financial stress that she was experiencing and the paroxsymal anger/stress event at work the night previous to the grand-mal type episode.
- Scott
Posted by SLS on April 1, 2001, at 14:55:43
In reply to Re: TLE, posted by Adam on March 31, 2001, at 22:06:30
> Hmm. Now that I think about it, I seem to remember something about changes in the brain that could be manifested in other regions besided the temporal lobe.
I am too lazy to try to find it again, but I recall that an initiating focus located in the thalamus can be referred to epileptiform activity in the temporal lobe. I read this when I was doing a very quick search regarding social anxiety and panic attacks being linked to ictal events occuring in the temporal lobe. Don't trust my memory, though. It has proven less than adequate over the last twenty years. :-) :-(
- Scott
Posted by SLS on April 1, 2001, at 16:34:34
In reply to Re: TLE, posted by SLS on April 1, 2001, at 14:55:43
> > Hmm. Now that I think about it, I seem to remember something about changes in the brain that could be manifested in other regions besided the temporal lobe.
> I am too lazy to try to find it again, but I recall that an initiating focus located in the THALAMUS can be referred to epileptiform activity in the temporal lobe. I read this when I was doing a very quick search regarding social anxiety and panic attacks being linked to ictal events occuring in the temporal lobe. Don't trust my memory, though. It has proven less than adequate over the last twenty years. :-) :-(
Sorry,Should be:
AMYGDALA and HIPPOCAMPUS
Pain in the ass memory...
Pain in the ass motivational deficit...
Please see:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3168957&dopt=Abstract
- Scott
Posted by Elizabeth on April 5, 2001, at 8:04:01
In reply to epilepsy?! (long, some ranting), posted by Elizabeth on March 30, 2001, at 6:20:36
Thanks, everyone, for your thoughtful replies. I don't know what to make of the whole thing.
Adam: to clarify, the doctors didn't think that the respiratory episode ("acute respiratory distress syndrome") was directly due to a seizure. Rather, it was due to aspiration, which they thought could have happened as a result of a partial seizure.
Posted by Adam on April 7, 2001, at 15:07:10
In reply to Re: epilepsy?! (long, some ranting), posted by Elizabeth on April 5, 2001, at 8:04:01
I hope they are progressing toward a good diagnosis. That will, of course, be the key to effective treatment.
There was one other, very ideosyncratic, symptom my old g.f. used to complain about that I remember: Mouth noises. Specifically, she simply could not stand other people making them. Chewing gum too vigorously (which I did...I like to chomp), eating a thick PBJ sandwich, you name it. It really had an effect on her, like worse than running fingernails down a chalk-board. Why I don't know, but she insisted it was somehow tied to the TLE.
This is a touchy subject, and I don't mean to open one of those proverbial cans o' worms, but...
Around the time my g.f. was first displaying symptoms of TLE (just starting college), she dropped a doozie on me: She came out as bisexual, to me, and to somebody else, if you know what I mean. I did not make the connection at the time, though the timing was peculiar. I think the idea that one's sexual orientation could, in some circumstances, be linked to a neurological disorder is not without controversy. Years later, though, when discussing that whole period of my life with a therapist, and blaming myself for how I dealt with it, I was informed by the therapist that such changes were actually classic hallmarks of TLE. He really wanted to stress that point. I had read TLE makes one "hyposexual." That is not the word I would have used to describe her. Don't know what to think except that TLE seems to be assiciated with changes in sexual functioning and/or interest in some individuals. College is the time for experimentation, so who knows.
I don't know if any of this sounds familiar, but I thought I would throw it out there.
Again, best of luck.
> Thanks, everyone, for your thoughtful replies. I don't know what to make of the whole thing.
>
> Adam: to clarify, the doctors didn't think that the respiratory episode ("acute respiratory distress syndrome") was directly due to a seizure. Rather, it was due to aspiration, which they thought could have happened as a result of a partial seizure.
Posted by Lisa Simpson on April 9, 2001, at 12:45:51
In reply to Re: epilepsy?! (long, some ranting), posted by Elizabeth on April 5, 2001, at 8:04:01
Hi Elizabeth. I was very interested to read about what happened to you... and very sympathetic. I have had seizures in the past, and they could not find out the reason. Scans etc. came out negative. The seizures are very frightening. And I always bite right through my tongue, which is very painful! I wish I could find out what causes mine.... although the last one (and apparently the worse one) was preceded by me getting extremely upset over something (I thought my 8-year old daughter had not been picked up after a gym class, and I was going out of my mind with worry.) I am sure that my getting in this state made me have a fit.
Anyhow, I wish you the best, and please let me know if you do ever find out anything about what might have caused it.
Lisa
Posted by Elizabeth on April 11, 2001, at 9:21:01
In reply to Re: epilepsy?! , posted by Lisa Simpson on April 9, 2001, at 12:45:51
Hi Lisa.
Most people who have seizures don't know what causes them. There might be triggers (like strobe lights or sleep deprivation, which is why those things are sometimes used when you have an EEG; stress, as you've noticed, can be another trigger) but most epilepsy is idiopathic meaning that the underlying causes are unknown. (Sometimes people have seizures for other reasons such as a brain tumor, an electrolyte imbalance or vitamin deficiency, an infection such as viral encephalitis, certain drugs (notably tricyclic ADs and phenothiazines), etc.)
A lot of the time, limbic seizures won't show up on EEGs, and the MRI will not show any lesions. This is one use for SPECT and other functional brain scans.
I am still waiting to see a neurologist to find out whether my SPECT scan really indicates epilepsy or not (and if not, what it might mean). The doctors I saw at the hospital didn't seem to know but had some (probably completely random) guesses. If I ever do get a conclusive answer I will post it. < g > The chances that I will find out a cause, though, are slim.
Posted by Lisa Simpson on April 12, 2001, at 11:15:05
In reply to Re: epilepsy?! Lisa, posted by Elizabeth on April 11, 2001, at 9:21:01
Hi Elizabeth - thanks (again!) for your reply. You obviously know a lot more about seizures than I do! Can I ask you, are you in the medical profession at all?
Would you know, for instance - if someone had a seizure as a result of drinking too much alcohol (this is possible, I think?), would this show up in an examination at hospital?
TIA for any info.Lisa
Posted by Elizabeth on April 14, 2001, at 4:09:29
In reply to Re: epilepsy?! Lisa, posted by Lisa Simpson on April 12, 2001, at 11:15:05
> Hi Elizabeth - thanks (again!) for your reply.
You're welcome, of course. :-)
> You obviously know a lot more about seizures than I do! Can I ask you, are you in the medical profession at all?
No. I've been reading up on them recently since the suggestion that I might be having them.
> Would you know, for instance - if someone had a seizure as a result of drinking too much alcohol (this is possible, I think?), would this show up in an examination at hospital?
If the cause was unknown, the hospital would do a tox screen, and alcohol is one of the drugs they screen for. However, whether it would show up would depend on how long ago the person had drunk the alcohol. For example, it may have been several hours before my boyfriend found me and got me to the hospital (and who knows how long it took them to get a blood (or urine?)) to send to the lab. By that time, alcohol could have been metabolised completely (IIRC, alcohol's rate of metabolism is complicated and depends on a lot of different things such as how much has been consumed, body weight, presence or absence of food in the stomach, etc.).
It might be a good idea for paramedics to give a breathalyser test in cases when they think that an unarousable patient might have been drinking. That way they would be more likely to get a useful result, and this kind of test is something that paramedics could do.
This is the end of the thread.
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