Examination of Drunken Person

Examination

1. Drinking and driving

2. Public nuisance
3. Domestic or public violence
4. Drunk in the work place
 Law: Motor Traffic Act – Sec. 151

• 151.1 – can’t drive after consuming

Alcohol or Drugs
• 151.1B – causing injury or death is guilty
of an offence
• 151.1C
• 151.1C.a – if police officer suspects Alcohol,
He can do

BREATHALYZER test or can produce to a

JMO for clinical Ex
151.1C.b - If Breathalyzers test (+) ve,

- JMO’s clinical Ex (+) ve,

- If suspect refuse to be
examined by JMO,

He is considered to be under influence of

Alcohol.

(therefore to say a person is under influence of

alcohol, above 3 methods can be used)
151.1C.c – If police officer suspects Drugs,
he can produce him to the JMO.

151.1C.d – JMO’s report is sufficient to say

he is under influence of Drugs.

151.1C.e – can arrest without a warrant.

151.1D – Breathalyzer test regulations

• The legal limit for Breathalyzer test is at or

above 80mg% of blood alcohol concentration
(BAC)
DRIVING UNDER THE INFLUENCE
INVESTIGATION AND ARREST
 REASONABLE SUSPICION TO STOP

There are several situations in which the Officer will come

into contact with a driver, some examples are:

- The driver has been involved in an automobile

accident; the officer has responded to the scene
and is conducting an investigation.

- The driver has been stopped at a sobriety

checkpoint (also known as Roadblocks).
- The Police have received a call, possibly from an
anonymous citizen, that a described car has
been driving erratically. The Officer should verify
the erratic driving before pulling the driver
over. In some cases, the driver will no longer be
in the vehicle.
- The Officer on patrol has observed erratic,
suspicious driving, or a series of Traffic
Infractions indicating the possibility that the
driver may be impaired. This is by far the most
common reason for stopping a suspect.

- A Police Officer has stopped a vehicle for a

lesser traffic offense, notices the signs of
intoxication, and begins the due investigation.
 INVESTIGATION

The officer will typically approach the driver's window and ask some
preliminary questions. During this phase of the stop the officer will
note if they detect any of the following indicators of intoxication

- Odor of an alcoholic beverage on the driver's breath or in the

car generally.

- slurred speech in response to the questioning.

- watery, blood shot, and/or reddish eyes.

- flushed face.

- droopy eyelids.
- difficulty in understanding and responding
intelligently to the questions.

- fumbling with his or her driver's license and

registration.

- the plain-view presence of containers of

alcoholic beverages in the vehicle.

- admission of consumption of alcoholic

beverage.
If the officer observes enough to
have a reasonable suspicion to
legally justify a further detention
and investigation, they will ask the
driver to step out of the vehicle.
Some other countries ---> sobriety test and
breathalyzer test both done in field by the police
officer……if positive then to the second
breathalyzer test and if necessary to the JMO and
blood test.

In SL ---> breathalyzer test done by police officer

or examination done by JMO but no blood test.
BREATHALYZER / BREATH ALCOLYZER
 Instructions to PO

• Check expiry date of the breathalyzer.

• Give a glass of water to wash mouth.
– Alcohol can remain in mouth and can give rise to false (+)
ve.
• Do the test after 20minutes.
– Alcohol can remain in mouth for 20minutes.
• The test can be performed at a roadside.
• Police officer & driver is enough.
Ask him to take a deep breath.
Ask him to blow the bag fully through the tube.
Then seal the tube.
Observe for colour change -->Yellow become Green.
Yellow substance is K-dichromate + H2SO4
Green substance is K-chromate.
If it goes beyond 80mg mark ( changing the colour)
--> consider as under influence of Alcohol.
Police officer gives the report after signing it.
For the first time in Sri Lanka the police
have supplied Alcolizer LE 5 Series (Breath
test) Detection units since June 2013.
BREATHALYZER TEST
Under the regulations gazetted,
only a police officer empowered to
perform a such test. devised must
be approved by the inspector
general of police.
WHEN PRODUCED TO JMO FOR
EXAMINATION OF THE SUSPECT…………

the police officer should not be present in the

room during the examination.

He may remain just out side the room in case the

suspect turn violent or tries to run away.
 PURPOSE OF EXAMINATION

1. To exclude natural disease which would

mimic alcohol
2. To exclude injuries which would mimic or
aggravate the effects of alcohol.
3. To detect the smell/ consumption or under
influence of alcohol
4. To decide whether the person is fit to be
in charge of a vehicle.

5. To decide whether the person is fit to be

detained.

6. To decide whether the person need

hospitalisation due to injuries/natural
disease or effects of alcohol.
 Clinical examination of a drunken person

• Authority ---> MLEF or Court order.

(- Departmental inquiry)?

• Preliminary notes
Patient ---> name, age, gender, address…etc.
PO ---> name, rank, number
Bystander ---> name.

• Consent ---> Informed, written, witnessed consent

Consent

. Informed written
. Explain the situation
. Explain the consequences of
giving consent and not giving
consent.
Observation
• Gait

• Cloths disarray, vomits, dirt, wrong buttoning…etc.

• Speech slurred, talkative, mute, boasting

• Appearance

• Behaviour

• Smell of alcohol
If patient refuse to be examined by the Doctor.,
Dr. cannot examine him, but he can mention his
observations to the courts.

Therefore Dr. can write in remarks column of

MLEF that the patient did not give his consent
for examination.
History
. About the incident
When, where, How, Ect.,

. After the incident

. Before the incident

. About consumption of alcohol

Type of drink/ amount/ time/
meal/events after the drink/ habitual
drinking/ frequency of alcohol / any
alcohol after the incident
Past medical history

Head Injury/ cerebral tumour/

CVA/ epilepsy/ multiple sclerosis/
acute vertigo/ diabetes/
thyrotoxicosis/CRF/
cirrhosis/psychosis/ co poisoning/
drugs
(to exclude the DDs of drunkenness)
Preliminary investigations

Photographs- if indicated

X-rays- if indicated, eg. If Suspect

head injury

Trace material collection- if indicated

Eg. Vomitus for analysis
Examination

• General examination Ht, Wt, body built…ect.

. Pulse /BP
. Respiratory rate/ breath smell
. Features of chronic alcoholism
. Natural diseases
. Injuries
Specific examination ( To exclude DD)

CNS

• Level of consciousness
altered, confused, coma

• Orientation
- Place
- Person
- Time
. Hearing --> reduced
. Speech --> slurring, dysarthria
. Gate --> ataxic, wide based
. Coordination
Finger – finger (FF)
Finger – nose (FN)
Pin pick (PP)
Straight line (SL)
Romberg (RB)
Reaction time (RT) Time taken to act after seeing
something
ask him to walk along a straight line & ask
him to turn --> he loses his balance
 ask him to draw a star.
- ask him to write his name.
- ask him to sign.
Reflexes - AJ, NJ  delayed.
Plantar reflex  upward
(Babinski (+) ve).
Examination of the Eyes

• Field of vision --> “tunnel vision”.

• Acuity --> ↓ed visual acuity due to dilatation

of pupils.
• Colour vision --> ↓ed.

• Extra ocular muscles paralysis --> double

vision.

• Intrinsic muscle paralysis --> ↓ed pupil

reaction, delayed light reflex.
– Nystagmus

. Horizontal gaze nystagmus (HGN) results from the

inhibition of the smooth muscles of the eye
. positional alcohol nystagmus (PAN)
By acting on the vestibular system

PAN 1, is associated with acute elevation of blood

alcohol, tending to occur about 30 minutes after
alcohol ingestion. In PAN I the fast phase of
nystagmus is in the direction toward which the
head is turned.

PAN II normally occurs at about 5–6 hours after

drinking and is characterized by nystagmus in the
opposite direction to that seen in PAN I
Acute intoxication features

• Head --> Eyes congested

Face flushed
Mouth – smelling of alcohol,
vomitus can be present.
• Skin -->warm (when BAC is very high-
hypothermic).
• Respiratory --> RR is ↑ed
(if BAC is very high – can be ↓ed).
CVS
PR is increased (if BAC is very high – can
be↓ed)
Rapid bounding pulse ( PP is high)

BP SBP – not increased due to alcohol alone.

DBP – reduced
STATES THAT MAY MIMIC ALCOHOL INTOXICATION

1) hypoglycaemia and diabitic pre coma

2)neurological states (dysathria , ataxia , tremor, drowsiness)
3)hypertension (impending stroke)
4) head injuries
5)carbon monoxide poisoning
6)other metabolic disorders
7)hyper pyrexia
8)hypoxic states
9)psychiatric disorders
10)drugs
Head injuries
Can mimic intoxication.
Can mask intoxication.
Can aggravate intoxication.
Diseases or disorders

• Metabolic
Pancreas --> Hypoglycemia,
Hyperglycemia.
Thyroid --> Thyrotoxicosis.
Liver --> Liver failure.
Kidney --> Renal failure.
Metabolic Effects

hypoglycermia

may accompany alcohol intoxication because of

inhibition of gluconeogenesis.

The usual features of hypoglycermia,

- flushing,
- sweating,
- tachycardia.
Neurological disorders
Cerebral/Cerebella tumors
Epilepsy/CVA
Vertigo/Dementia

Psychological disorders
Depression
Mania
Poisoning

• Gas poisoning  CO, CO2…ect.

• Drug poisoning  Atropine / Antihistamine

Barbiturate, Bensodiazepine
Morphine, Insulin
 Problems related to the
examination of drunkenness
1. Related to Suspects

• If delayed presentation, no evidence of intoxication

• Sobering effect --> when a chronic alcoholic is drunk,

he becomes clinically normal

• Chronic abusers may be familiar with the tests.

• Fatigue/Medication/Diseases/Stomach conditions/
psychological effects
• Educational state/ IQ of the suspect
2. Factors dependent on the doctor
Attitude/ experience/ fatigue/
emotional involvement

3. Method of examination/ conduction of

tests

4. Method of interpretation
 Problems in clinical Tests
• No clinical test is specific for alcohol.

• All signs & symptoms have DDs.

• Therefore has to use many criteria as possible.

• Alcohol is smell less. Smell is due to the additives.

• Smelling of liquor can be (+) ve but at the same time he

can be suffering from another disease, hence doctor can
misinterpret as intoxication.
Conclusion:
-If Under influence of alcohol
- his ability to drive is lost.

-If only smelling

- driving ability spared, but legally he
can’t drive.

-If mild to moderate

- can be kept in custody.

-If severely under influence of alcohol

- admit to a hospital.
 Chronic intoxication features
• Neglect features – dirty, ulcers, sores, rashes, head
lice…ect.
• Malnutrition – wasted, cachectic, features of
vitamins deficiency.
• Specific features.
Head ---> parotid enlargement.
Eyes ---> muddy sclera, jaundice can be present.
Respiratory ---> bronco pneumonia, lobar
pneumonia.
Heart ---> dilated cardiomyopathy, myocarditis.
Blood ---> ↓ed Hb, ↓ed WBC, ↓ed Clotting factors,
↓ed Platelets.
 Clinical feature of chronic alcoholism

Liver failure --->

protein – oedema, ascitis, pleural effusion…
clotting factors – bleeding…

↑ oestrogen ---> gynaecomastia, testicular atrophy,

altered hair distribution, palmer erythema, spider naevi

↑ N2 toxic production ---> hepatic encephalopathy –

flapping tremor
 Portal hypertension

---> splenomegaly, hepatomegaly, caput medusa,

oesophageal varices…ect.

• Stomach --> gastritis, erosions, gastric ulcer…

• Pancreas --> acute/chronic pancreatitis, diabetes mellitus
• CNS --> Peripheral neuropathy.
• Chronic sub dural haemorrhage.
• Hepatic encephalopathy – cerebral oedema.
• Wernicke’s encephalopathy – memory loss, Necrosis &
haemorrhage around mamillary bodies – (mafia fewa
bignamy syndrome),