Blood Alcohol Level? s r @= ?0 ? )MH Xo E x]kTu?;/V`"@! vd @p#IAxe^! YvlW%UrJDY!""~K? aV#!,(; *;Y er{{Tis??!F[B t?M^s{!?SZEpOZa?^V[T;p A[m?v^#^/g'bv)5%?V q ?wv b^` /$D&\-;}~Kvm=]HRKmm#alMn"Kb*,x+}hVX?n&ZN4r't-/|:}:s&m@yYöq|c1{jC.L sm_Tst?YY!|-2]3P i~?F Qju21# Eo?qUbG-u].T7 /IWh_s ~G~~VV??u_# :=1Mq3q :{ ?\q72*nvgq 7rs WYkStPI+7/X4Q@{7_nd8k :|F?Xo2p:eW 'G' ?VI]~== $f&U y?[ 6@p& ?b+ Y/&&cx6?* ,W}qDiF[dM^???i %{+)e7 6@gXh- M+dk!?s@F:B1me 3{ : :s\o3gwb zv9C?3#g,w vt3z~{vQBB?K1?Ty?t]o+9rP\LH\n/h%+9rPB1 atGzC U W rG*W0rr+|ra5Pr?/7B`y@pFL! W@N{;r t`\:WX$XOu^Sbq}Ayx 1mt` c%7 7 |`CgW{s8r[/7GZ 9z Yn 82j?{FA# Yn 8 ]@_C |¸m|,__W|6;llsiG2_nF$Prr#\7} ;_p r3#W,7zwniO\z¸?D0W?,?e~i Gy^AOq fa1?Vy3?[} #~H~~/l|_:h*"nlq c%ocmCgW26t6~o[p?/7vz2ow?k(z(_06}|2ow??QWdS$KQ/Bj8sNS;?nL5?6t/oES iw{A+?6tF35" i cXt=cOJ?= lC_yzELrR1Z;?"ni,.}EOr?d\/'$?H|E1qVTP/"a'?n t/}dN'Cmn/h%kCC m| a nhmhHsmtpN : iCgG4w~6?[wTyNs'|g &wF;s\o;9Yl?zGS_A?GY$/Oz6R{\:'? =]LU}P !8kp( ^J8P p ? Gp(6t#PCm|.?CO?}??9eC;_04} MPr#?M!G;s8Own'z90GtN*#cg?cR?~?K?{4]= |zsO_?W§ t)?Vhat??d :Om(}|l?Oa?j(|l?OMe i_n5}|2?}]?9]:8?IOW_$??:,?L 99-?6~ iC0 QHl +?6t6~% 99?U#Q_?{Îl? +w r#Y Kw`?Z v?BzwF\7\&I?s?|? u\p}Fq,]{?yB;l{f\&~Our~O!l?|G cr#\:|Q;l[f\&~Kur~K"l[#:.xy&_pXU,?O h}COp?a9Wq r b m^#hGYf#!oJ ?z&~"z" bS ;gZ}8::?q=?~o8?qYGk #U| 9I#Mmu}! t??#x?q:6 ?Q;[Ze) ;u (-KaK~bgq\}D4?)wbo f?L ;??%x$LCPOm?K/)w3_8?2b?;rql%?uqyq%Q;anGvBO 5 ( \ , r o b i n . r o o m @ s o r a d . s u . s e : m a i l t o : r o b i n . r o o m @ s o r a d . s u . s e # y 9 0 D o c u m e n t W o r d . D o c u m e n t . 8 0 $ M i c r o s o f t D o c u m e n t ` / 0 D A r i a l n g s 0 t t * 0 D W i n g d i n g s ? 0 t t * 0 @ . @ n ? " d d @ @@ `` @ 8 L + , " $ ?0 ? )M 0 A A @ w ?; ?; g 4 K d K d * 0 p p p @ F 1 0 . 0 A c u t e i n t o x i c a t i o n d u e t o u s e o f a l c o h o l A . T h e g e n e r a l c r i t e r i a f o r a c u t e i n t o x i c a t i o n ( F 1 x . 0 ) m u s t b e m e t . G 1 . T h e r e m u s t b e c l e a r e v i d e n c e o f r e c e n t u s e o f a p s y c h o a c t i v e s u b s t a n c e ( o r s u b s t a n c e s ) a t s u f f i c i e n t l y h i g h d o s e l e v e l s t o b e c o n s i s t e n t w i t h i n t o x i c a t i o n . G 2 . T h e r e m u s t b e s y m p t o m s o r s i g n s o f i n t o x i c a t i o n c o m p a t i b l e w i t h t h e k n o w n a c t i o n s o f t h e p a r t i c u l a r s u b s t a n c e ( o r s u b s t a n c e s ) , a s s p e c i f i e d b e l o w , a n d o f s u f f i c i e n t s e v e r i t y t o p r o d u c e d i s t u r b a n c e s i n t h e l e v e l o f c o n s c i o u s n e s s , c o g n i t i o n , p e r c e p t i o n , a f f e c t , o r b e h a v i o u r t h a t a r e o f c l i n i c a l i m p o r t a n c e . G 3 . T h e s y m p t o m s o r s i g n s p r e s e n t c a n n o t b e a c c o u n t e d f o r b y a m e d i c a l d i s o r d e r u n r e l a t e d t o s u b s t a n c e u s e , a n d n o t b e t t e r a c c o u n t e d f o r b y a n o t h e r m e n t a l o r b e h a v i o u r a l d i s o r d e r B . T h e r e m u s t b e d y s f u n c t i o n a l b e h a v i o u r , a s e v i d e n c e d b y a t l e a s t o n e o f t h e f o l l o w i n g : & C . A t l e a s t o n e o f t h e f o l l o w i n g s i g n s m u s t b e p r e s e n t : & & : P . 4 = ' + n ) The other ICD-10 code for intoxication -2 * * $ B. There must be dysfunctional behaviour, as evidenced by at least one of the following:1) disinhibition;2) argumentativeness;3) aggression;4) lability of mood;5) impaired attention;6) impaired judgment;7) interference with personal functioning.C. At least one of the following signs must be present: 1) unsteady gait;2) difficulty in standing;3) slurred speech;4) nystagmus;5) decreased level of consciousness (e.g. stupor, coma);6) flushed face;7) conjunctival injection 0 P P P b 5 - R ( Clinical assessment & BAC (Y91 vs. Y90) ) ) $ F a c t o r s w h i c h m i g h t a f f e c t t h e r e l a t i o n s h i p : E x t e n t o f a s s e s s o r s e x p e r i e n c e O p p o r t u n i t y t o o b s e r v e o r t e s t b e h a v i o u r P r o x i m i t y i n t i m e o f B A C a n d a s s e s s m e n t E x t e n t o f s u b j e c t s t o l e r a n c e o f a l c o h o l V a r i a t i o n s i n d r u n k e n c o m p o r t m e n t C u l t u r a l l y - i n f l u e n c e d a s s u m p t i o n s a b o u t s o c i a l l o c a t i o n a n d o n r e c o r d i n g o f i n t o x i c a t i o n & - - l + Clinical assessment and BAC: prior studies , , ( J e t t e r , 1 9 3 8 : 1 3 % o f t h o s e a d m i t t e d w i t h a c u t e a l c o h o l i s m h a d z e r o B A C H o n k a n e n , 1 9 7 7 : 1 4 % w i t h n o i n t o x i c a t i o n h a d p o s i t i v e B A C , 1 2 % h e a v i l y i n t o x i c a t e d h a d z e r o B A C S i m i l a r r e s u l t i n s e c o n d F i n n i s h s t u d y T e p l i n & L u t z 1 9 8 5 : A l c o h o l S y m p t o m C h e c k l i s t : 0 . 8 5 c o r r e l a t i o n w i t h B A C U S f i e l d s o b r i e t y t e s t s f o r l a w e n f o r c e m e n t : m o s t l y p o s i t i v e , e v e n d i s t i n g u i s h i n g . 0 8 % s e p a r a t e l y f r o m . 1 0 % S o m e m o r e p e s s i m i s t i c r e p o r t s T y p i c a l l y t e s t m o v e m e n t a n d c o o r d i n a t i o n c a n s u c h t e s t s b e u s e d i n a b u s y E R ? T Z { x Z { x 6 C @ Y90 & Y91 in the WHO Collaborative Study on Alcohol and Injuries A A $ C o m p a r i n g : B A C m e a s u r e m e n t ( b r e a t h a l y z e r ) C l i n i c a l a s s e s s m e n t b y p h y s i c i a n o r n u r s e I n c l u d e d r e c o r d i n g o f c l i n i c a l s i g n s o f i n t o x i c a t i o n A s s e s s m e n t b y i n t e r v i e w e r ( 4 s i t e s ) E q u i v a l e n c i e s a s s i g n e d f o r c o m p a r i s o n : N o i n t o x i c a t i o n d" 0 . 5 9 p e r m i l l e M i l d i n t o x i c a t i o n 0 . 6 0 0 . 9 9 p e r m i l l e M o d e r a t e i n t o x i c a t i o n 1 . 0 0 1 . 9 9 p e r m i l l e S e v e r e / V e r y s e v e r e i n t o x i c a t i o n 2 . 0 0 a n d m o r e T a u - B c o r r e l a t i o n 0 . 6 8 B e t t e r a g r e e m e n t o n n o n e v s . s o m e t h a n a t h i g h e r l e v e l s P I P 5 P $ P ' P P P 8 P I 5 $ ' 8 } L Conclusions and options There is an association between assessment and BAC, but only medium strong at any site.Y91 is not a satisfactory substitute for Y90BAC worth routinely measuring (though not always causal)Summary codes vs. full BAC?Recategorize?Developing clinical instrument to estimate BAC?(rather than intoxication)Or separate Y91, use it as a measure of ostensive drunkenness?Relation of F10.0 to Y90, Y91? 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"B ND zF H J L *O VQ S U K[ Y w Oh +'0 ` h $ @ L p | The relation between Blood Alcohol Content and clinically assessed intoxication: lessons from applying the ICD-10 Y90 and Y91 codes in the emergency room Gretchen Thomas Cheryl Cherpitel 2 Microsoft Office PowerPoint @ @/ @ L21@ `}0 G $ g [ y 33 - - $ x x - - ' @ Arial - . H 2 + The relation between Blood Alcohol Content r . "System 04 - @ Arial - . @ 2 & and clinically assessed intoxication: . - @ Arial - . 3 2 lessons from applying the ICD . - @ Arial - . 2 l - . - @ Arial - . 2 n 10 Y90 and . - @ Arial - . 6 2( Y91 codes in the emergency room . - @ Arial - . 28 B Robin Room . - @ Arial - . N 2? / Centre for Social Research on Alcohol and Drugs . - @ Arial - . % 2G 8 Stockholm University . - @ Arial - . ! 2O 9 Stockholm, Swedeni . - @ Arial - . ( 2V 3 robin.room@sorad.su.se . - - V 3 V m - @ Arial - . [ 2f 8 Presented at an International Conference on Alcohol and . - @ Arial - . 6 2l Injury, Berkeley, California, 3 . - @ Arial - . 2l ^ - . - @ Arial - . 2l ` 6 October, 2005 . - . +,D ?. +, ? @ A B C D E F G H I J K L M N O P Q R S T U V W X Y [ \ ] ^ _ ` a c d e f g h i k l m n o p q t R o o t E n t r y dO ) P i c t u r e s C u r r e n t U s e r j S u m m a r y I n f o r m a t i o n ( Z P o w e r P o i n t D o c u m e n t ( D o c u m e n t S u m m a r y I n f o r m a t i o n 8 b
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DUI / DWI, Drinking 
