Our Services: Medical records
Was the driver chemically impaired?
 A
young lady was the driver of a van when her vehicle was
struck from behind. The force of the impact caused her to
be thrown from the van. A blood sample taken from the driver
showed a level of 0.035 mg/liter of Morphine, leading the
attorneys to conclude that she was impaired at the time
of the accident.
A young woman was brought into
the emergency room following an accident. Her face was swollen
and there was a dressing under her nose. Her urine contained
0.4 mg/liter of benzoylocgonine, a metabolite of cocaine,
leading the attorneys to conclude that he was impaired at
the time of the accident.
A man was driving through an
intersection when his car struck another. His emergency
room record stated “AOB” and the physician progress
notes stated “+ETOH.” A BAC was ordered. The attorney
representing her wanted to know what these terms meant and
if he was impaired when he was in the accident.
The determination of
impairment rests on a careful analysis of specimen values
and timing. In the first situation, it was tempting to conclude
that the driver had taken either heroin or morphine prior
to the accident. Heroin metabolizes into morphine, and got
its name because it was the “heroic drug” that
was supposed to save people from opium addictions. Heroin
can be injected or inhaled, and shows up in the blood and
urine as morphine. In this case, the driver denied using
heroin before the accident. The question of timing of the
specimen was crucial. Review of the emergency room record
shows that the patient received 5 mg of morphine intravenously
at 9:00 AM in
the emergency room. The blood specimen taken to test for
drugs was drawn at 9:30
AM . Until we pointed out the timing, the attorneys
had not realized that the patient was given morphine in
the emergency room before the blood was removed.
 In
the second situation, the substance in question was cocaine.
This substance can be chewed, sniffed, injected, or smoked,
yielding different levels of cocaine depending on the dose
taken. Benzoylecgonine is present in the body for 2-3 days
following use of cocaine. Benzoylecgonine peaks in the urine
within 4-8 hours and diminishes slowly to an average of
0.4 mg/liter for 48-72 hours. The answer to whether this
woman was impaired, and how she got cocaine, was found in
her surgical history. At first, the emergency room personnel
assumed that the First Aid Squad had applied a dressing
to the nose of the patient. However, when the patient was
questioned, she said she had a nose job two days before.
A submucous resection (or “nose job”) involves
the use of cocaine to constrict the blood vessels in the
nose. The application of cocaine to her nose resulted in
detection of benzolecgonine on the day of the accident.
It was unlikely that it had any effect on her ability to
drive two days later.
In the third situation, our
skill in deciphering medical abbreviations led us to the
conclusion that the emergency room personnel smelled alcohol
on the patient’s breath. AOB stands for “alcohol
on breath.” ETOH is the chemical formula for ethyl
alcohol, hence a + (positive) ETOH has the same meaning
as AOB. To determine the patient’s blood alcohol level,
a BAC (blood alcohol concentration) was ordered. This test,
also referred to as BAL (blood alcohol level) was .09. The
driver said he was in a bar drinking wine before the accident.
Using a blood alcohol concentration calculator and her recorded
weight of 170, it could be determined that he had to have
consumed at least five 3.5 ounce glasses of wine to result
in this blood alcohol level 1 hour after leaving the bar.
With the national push to define a BAC of .08 as impaired,
there is no question that he was impaired at the time of
the accident.
Evaluation of toxicology results
is made easier with a legal nurse consultant and standard
references such as Baselt, Randall, Disposition of Toxic
Drugs and Chemicals in Man, and Garriott, James, Garriott's
Medicolegal Aspects of Alcohol, which comes with a blood
alcohol concentration calculator. Contact
us for help with deciphering these issues for you.
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