It means alcoholic intoxication. Establishment of the fact and degree of alcoholic intoxication of living persons - abstract

bibliographic description:
The degree of alcoholic intoxication - 2012.

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The degree of alcoholic intoxication - 2012.

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— 2012.

In the work of a forensic expert, the issue of the lethal concentration of ethyl alcohol in the blood is important. With the introduction modern methods determination of the level of ethanol, sufficiently accurate and specific, requires a unified scheme for assessing the quantitative content of alcohol in the blood in relation to its functional effect.

For practical expert work, in accordance with the proposed V.I. Prozorovsky, I.S. Karandaev and A.F. Rubtsov (1967) criteria, the following indicative scheme can be recommended for determining the degree of alcohol intoxication:

Degrees of alcoholic intoxication (1967)

• less than 0.3 ‰ - no influence of alcohol;
• from 0.3 to 0.5 ‰ - insignificant influence of alcohol;
• from 0.5 to 1.5 ‰ - slight intoxication;
• from 1.5 to 2.5 ‰ - moderate intoxication;
• from 2.5 to 3.0 ‰ - severe intoxication;
• from 3.0 to 5.0 ‰ - severe alcohol poisoning, death may occur;
• from 5.0 to 6.0 ‰ - fatal poisoning.

These numbers apply to adults. In children, alcohol intoxication and ethanol poisoning occur at other levels of alcoholism.

The above criteria were proposed to determine the degree of alcoholic intoxication in living persons, however, they can also be used to assess the concentration of ethyl alcohol in the blood from a corpse. Evaluation of such results should be carried out with the appropriate wording, for example: "... the detected concentration of ethyl alcohol in the blood of the corpse of a citizen ... during life could correspond ... to the degree of alcoholic intoxication."

Degrees of alcoholic intoxication (2016)

The depth of intoxication, the rate of its development depends on the amount of alcoholic drinks drunk, their strength and individual characteristics of a person. There are 3 degrees of intoxication:

• light - the concentration of alcohol in the blood is up to 2 ‰, which corresponds to 0.5-1.5 ml of pure ethanol per 1 kg of human body weight;
• medium - 2-3 ‰ of alcohol is detected in the blood, i.e. ethanol was taken 1.5-2.5 ml per 1 kg of tepa mass;
• severe - occurs when the concentration of ethanol in the blood is 3-5 ‰ or more, which corresponds to 2.5-4.5 ml of alcohol per 1 kg of body weight. With a severe degree of intoxication, a coma develops, which can be the immediate cause of death along with asphyxia due to deep aspiration of vomit, acute heart failure.

Literature data and expert experience allow us to consider average lethal alcohol concentration 3.5-4.0 ‰, and a concentration of 5.0 ‰ and above is usually fatal.

However, quite often there are cases when death from ethyl alcohol poisoning occurs when its amount in the blood is less than 4.0-5.0 ‰ and in the absence of pronounced painful changes in internal organs, which in themselves could cause death. In this regard, it should be noted that death from acute poisoning with ethyl alcohol can occur at any stage of alcohol intoxication: during the period of absorption, at the time of maximum alcohol content in the blood, but much more often during the period of its excretion (elimination phase). In the latter case, a relatively long period of time elapses from taking alcoholic beverages to the onset of death (10-20 hours), therefore, by the time of death, the concentration of alcohol in the body may be lower than 4.0-5.0 ‰. This is more common in young people who are not used to alcohol. In females, fatal alcohol poisoning can occur at lower concentrations of ethyl alcohol in the blood than in men. In addition, a subtoxic dose for a healthy person who is accustomed to alcohol can be fatal for the unaccustomed. The lethal blood alcohol concentration for people who are accustomed to alcohol is usually 30-60% higher than for those who are not used to or are not used to. However, in chronic alcoholics, death can occur from taking relatively large quantities ethyl alcohol.

In people unaccustomed to alcohol, with a single intake of large amounts of alcoholic beverages or high concentration alcohol, death often occurs in the resorption phase or at the beginning of the elimination phase.

To calculate the degree of intoxication, the maximum concentration of alcohol in the blood in ppm, the time for removing alcohol from the body, we recommend using the alcohol calculator we have written.

Literature

1. Issues of organizing the examination of alcoholic intoxication / Prozorovsky V.I., Karandaev I.S., Rubtsov A.F. // Forensic-medical examination. - 1967. - No. 1. - S. 3-8.
2. Supplement to the methodological letter "On the detection and determination of ethyl alcohol and blood and urine by the method of gas-liquid chromatography", M., 1971.
3. Methodological letter "On the detection and determination of ethyl alcohol in cadaveric material and forensic medical assessment of the results of forensic chemical analysis", M., 1961
4. Methodological letter "On the determination of ethyl alcohol and blood and urine of corpses by the photometric method", M., 1964
5. Methodological letter "On defects in the production of forensic chemical examinations", M., 1966
6. To the question of the functional assessment of the results of the forensic quantitative determination of alcohol in the blood of living persons and corpses / Prozorovsky V.I., Acherkan N.N., Levchenkov B.D. // Forensic-medical examination. - M., 1961. - No. 1. - S. 3-7.
7. Formulation of the pathological anatomical diagnosis in alcoholic illness(alcohol-induced pathology). Clinical guidelines / Frank G.A. et al. / Russian Society of Pathologists. - M .: Practical Medicine, 2016 .-- 20 p.

/ Plis S.S. // Selected issues of forensic medical examination. - Khabarovsk, 2018. - No. 17. - S. 185-187.

/ Nedugov G.V., Sharafullin G.V. // Bulletin of forensic medicine. - Novosibirsk, 2018. - No. 3. - S. 39-43.

/ Klevno V.A., Maksimov A.V., Kononov R.V., Krupina N.A. // Forensic Medicine. - 2017. - No. 3. - S. 4-12.

/ Prozorovsky V.I., Karandaev I.S., Rubtsov A.F. // Forensic-medical examination. - M., 1967. - No. 1. - S. 3-8.

/ Obukhova L.M., Erlykina E.I., Andriyanova N.A. // Forensic-medical examination. - M., 2014. - No. 6. - S. 33-36.

/ Ivanov N.A., Schneider N.M. // Forensic-medical examination. - M., 1962. - No. 2. - S. 41-42.

/ Pavlov A.L. - 2014.

/ Pavlova A.Z., Larev Z.V., Kalyokin R.A., Orlova A.M. // Selected issues of forensic medical examination. - Khabarovsk, 2018. - No. 17. - S. 235-237.

/ Bogomolov D.V., Denisova O.P., Zbrueva Yu.V., Dzhuvalyakov P.G. // Selected issues of forensic medical examination. - Khabarovsk, 2018. - No. 17. - S. 50-53.

/ Konev V.P., Goloshubina V.V., Moskovsky S.N., Bogza M.V., Sorokina V.V., Abubakirova D.E. // Bulletin of forensic medicine. - Novosibirsk, 2017. - No. 3. - S. 47-50.

/ Ulanov V.S. // Forensic-medical examination. - M., 2017. - No. 4. - S. 12-13.

The severity of alcohol intoxication can manifest itself in different ways. It may depend on many unrelated reasons. The most important of them is the individual characteristics of each individual person. Previous illnesses are of considerable importance, especially for pathologies of an organic nature. They often cause extremely fast or

The effects of alcohol and the development of intoxication

People's ability to drink alcohol is very different. In addition, it is important for what purpose and with what mood the alcohol is taken. If this happens at a festive celebration, then the obvious intoxication can come pretty quickly.

If an ordinary user consciously tries to continue to control the situation, then he can significantly delay the moment of intoxication. The type of drink consumed, the percentage of sugar and alcohol in it are of considerable importance for its depth and rapidity of development.

A certain role is played by the state of a person before drinking, both physical and mental. People suffering from alcoholism often experience atypical intoxication - dysphoric or mixed. It is rather difficult for them to distinguish the signs, the degree of alcoholic intoxication.

Intoxication stages

Various stages of intoxication are distinguished, differing in the sensations of a person and the external manifestations of his behavior. At first, an alcohol-containing drink causes a pleasant feeling of lightness and euphoria, gives a feeling of joy and high spirits, relieves fatigue and relaxes. As the amount drunk increases, these sensations often change to others, much less pleasant. It can be irritation and anger, hypertrophied resentment, aggression and loss of control over one's own behavior.

How stronger drink, the faster the symptoms of altered consciousness appear. An empty stomach also helps a lot. If there is at least some kind of food in it and the drink used has a small strength, then the process of development of intoxication does not occur so quickly. The manifestation of the degree of intoxication of an object directly depends on its mass, individual susceptibility and state at the moment. With a clearly pronounced neuropsychic stress of a person, alcohol has a less pronounced effect. This is due to the initial overvoltage of the central nervous system.

Easy stage

A person attracts attention due to heightened mood, gaiety, sociability. He tries to be pleasant and complacent, but it becomes difficult for him to maintain the ability to concentrate. A mild degree of alcoholic intoxication is characterized by somewhat cheeky and slow speech.

His judgments can become rather frivolous; the criticality of actions decreases, as well as the perception of various troubles. The surrounding reality is distorted for a person, he is not able to assess what is happening. Instincts inherent in the object are inhibited, skills are dulled,

Often a person overestimates his own capabilities, performs actions that are unusual for him in a normal state. These changes are observed already at the initial degree of alcoholic intoxication. They are caused by the toxic effect of alcohol on the nerve centers. But what is happening to them people clearly remember and can retell later.

Average

This is already quite a strong intoxication. All previous symptoms are aggravated, new ones are added to them. A distinct smell of alcohol comes from the person's mouth. His gait becomes wobbly and unstable, sometimes it becomes rather difficult to attract his attention. Initial signs of stunnedness may be observed. It is quite possible disorientation in space and violation of control of their behavior.

Loss of natural shyness is typical for this stage, causing sexuality, incoherent speech and loud swearing. Increased excitability with reduced self-control easily provokes quarrels, arguments and even fights. The average degree of alcoholic intoxication is characterized by memory lapses: there is a complete loss of individual fragments of what happened the day before. In the morning, a person may not remember everything that happened to him.

At this stage, various forms of deep disturbance of consciousness are often observed. Subject is usually unable to stand on its own. With great difficulty, you can get his attention. It is almost impossible to contact a person, he is indistinct: he mutters something unintelligible, repeats meaningless phrases and words.

His state can be different: he can be inhibited and lethargic, or, on the contrary, overly excited. The reaction to painful stimuli is significantly reduced. A person cannot write, he cannot use a familiar skill.

Deep intoxication against the background of severe intoxication of the body can turn into a coma, while the prognosis is not always favorable. Not everyone is able to reach this degree of alcoholic intoxication, many of them trigger protective reflexes of the body - nausea and vomiting interfere with further use.

The presence of various stages of intoxication is of interest to many citizens. The ability to drive vehicles depends on this, for example. Sometimes there are situations when it is necessary to find out exactly how drunk or sober an object is. For this, the indicators of the degree of alcoholic intoxication in ppm are calculated. A special device is successfully used, which is actively used by police services, doctors and ordinary citizens.

So what is the relationship between the amount of alcohol in the blood and the degree of intoxication?

• 0.3-0.5% - slight influence of alcohol.
• 0.5-1.5% - slight intoxication.
• 1.5-2.5% - average intoxication.
• 2.5-3% - severe intoxication.
• 3-5% - deep intoxication, alcohol poisoning, death is possible.
• Over 5% - severe fatal poisoning.

Intoxication: Modified Forms

If the subject has certain psychological disorders or special individual traits, his intoxication can take various atypical forms. It can be:

• Dysphoric. Even with a little use, a person, bypassing high spirits, demonstrates depression and aggressiveness, usually typical for more severe stages. This form of manifestation is typical for those suffering from chronic alcoholism.
• Hebephrenic. It is expressed in excessive foolishness, ostentatious gaiety, often turning into a riot. It is observed in various latent schizophrenic disorders. Occurs in adolescents.
• Paranoid. A person becomes suspicious and suspicious, he inadequately interprets the intentions and actions of others. This form is found in some types of mental disorders, especially in the presence of alcoholism.
• Hysterical. This form is observed in people of a special warehouse, egocentric, with high self-esteem. It manifests itself as an imitation of insanity, there are frequent threats of suicide, demonstrative attempts at suicide.

The harm of alcohol

Regardless of the amount drunk and the degree of alcoholic intoxication, alcohol always has a pathological effect on the body. Alcohol is officially recognized as a dangerous drug that can cause irreparable harm to health and be addictive. Among other things, alcohol has negative impact on the brain, which regulates the activity of all organs, affecting the harmonious functioning of all body systems.

The negative effect of alcohol is due to a violation of the supply of oxygen to the nerve cells, which gradually begin to die off. This affects primarily the intellectual abilities of the individual. Against the background of damage to the cerebral cortex and a decrease in brain activity, the behavior of the drinker is gradually changing not for the better. An obvious change in the addict's behavior, hobbies and addictions becomes noticeable.

How to determine the degree of intoxication?

It is possible to independently determine the severity of intoxication only approximately, by changing the nature of behavior. To do this, it is necessary to assess the behavior and speech of the drunk person, check his ability to coordinate movements, objective perception of the environment.

To determine the content, it is necessary to conduct a special analysis. However, its performance is directly related to the amount of time elapsed after drinking. The indicators will be the lower, the more it has passed since the moment of use. Not everyone is able to correctly assess their own capabilities, so do not abuse alcohol.

Criteria for determining the states of alcoholic intoxication and intoxication The conclusion "The fact of alcohol consumption has been established, no signs of intoxication have been identified" is carried out in the presence of convincing data confirming the fact of alcohol consumption, but in the absence of a clear clinical picture of alcohol intoxication. In these cases, the test with the Mokhov-Shinkarenko indicator tube (sobriety control) and the Rappoport reaction will be weakly positive, and the alcohol content in biological media fluctuates from 0.022% to 1%. With a mild degree of alcohol intoxication changes in mental activity are insignificant. There is an increase in vegetative-vascular reactions - skin hyperemia, injection of sclera, excessive sweating, tachycardia, increased blood pressure, rapid breathing, as well as nystagmus, dilated pupils; violation of the motor sphere - a change in gait, staggering when walking with fast turns, instability in a simple and sensitized Romberg position, inaccuracy in performing precise movements and coordination tests. With a mild degree of alcohol intoxication, the alcohol content in biological media ranges from 1 to 2%. With a moderate degree of alcohol intoxication more pronounced changes in mental activity are noted - an incorrect assessment of the situation, lethargy or agitation, aggression, dysarthria, salivation. Vegetative-vascular disorders are manifested in the form of hyperemia or blanching of the skin and mucous membranes, increased heart rate, respiration, fluctuations in blood pressure, sweating. Dilatation of the pupils, sluggish photoreaction, nystagmus, unsteadiness of gait, instability in the Romberg position, distinct violations of coordination tests, decreased tendon reflexes, and pain sensitivity are observed. The alcohol content in biological media in these cases ranges from 2 to 3%. With a severe degree of alcohol intoxication there is a violation of orientation, lethargy, drowsiness, low accessibility to contact, misunderstanding of the meaning of questions, tachycardia, arterial hypotension, pallor of the skin and mucous membranes, a weak reaction of the pupils to light, nystagmus, a sharp violation of gait, inability to stand independently and perform targeted actions, suppression of tendon reflexes, decreased corneal reflexes. The pupils are dilated, but in the transition to an alcoholic coma, the pupils can be narrowed. The alcohol content in biological media in these cases ranges from 3 to 4%. With an alcoholic coma impaired consciousness, lack of reactions to the environment, severe disorders of autonomic regulation, cardiovascular activity, a sharp decrease in muscle tone, absence of painful, corneal, tendon reflexes, pathological reflexes, hyperkinesis are noted. Involuntary urination, defecation, respiratory distress are possible, pupils are dilated, their reaction to light is absent. The alcohol content in biological media in coma is over 4%. A state of intoxication caused by narcotic or other substances. Such a conclusion is made in the presence of clinical symptoms of intoxication caused by the use of narcotic or potent substances, the absence of an odor of alcohol from the mouth and negative chemical tests for alcohol. In such cases, to confirm the state of intoxication, in addition to the clinical description of the symptoms of intoxication, the results of chemical studies of biological fluids are needed. Chief psychiatrist and narcologist of the CommitteeV. N. Kozyrev Deputy Chief Psychiatrist for AddictionA.A. Sergeev

The state of alcoholic intoxication is characterized by severe intoxication of the body. It manifests itself most vividly after drinking a large volume of alcoholic beverages. This is a temporary condition, which is accompanied by a violation of the psychological and physiological functions of the body. Human behavior and reactions change. Signs of alcohol intoxication are subjective, but some of them are common to all drinkers.

About the pathological condition

The condition in which autonomic, mental and neurological disorders occur due to the use of alcohol is called alcohol intoxication. It is the result of the influence of the decay products of ethyl alcohol on the human body. These toxic substances negatively affect the entire human body in general and the central nervous system in particular. The drunk person is no longer able to control himself. The severity of this condition depends on the individual tolerance of alcohol and the amount of alcohol consumed.

Alcohol is absorbed in all parts of the gastrointestinal tract from the moment it enters oral cavity and ending with the small intestine. The highest concentration of ethanol in the blood is observed one hour after drinking an alcoholic beverage. With the blood stream, it spreads throughout the body and penetrates into all its tissues. It is broken down in the liver by various enzymes... Ethyl alcohol is excreted in urine, sweat and exhaled air.

Pathological behavioral reactions and other negative manifestations are the result of the effect of ethanol on the cerebral cortex. Since the vasomotor and respiratory center is affected, after drinking alcohol, reflexes are weakened, the heart rate increases, and breathing changes. In most cases, alcohol intoxication is indicated by three signs: a wobbly gait, bad breath, and slurred speech.

Alcohol has a detrimental effect:

• on the heart and blood vessels. With alcohol abuse, the risk of alcoholic cardiomyopathy, arrhythmia, vascular occlusion and other pathologies increases of cardio-vascular system;
• organs of the gastrointestinal tract (GIT). Toxic decomposition products of alcohol irritate the mucous membrane of the digestive system, disrupting this process. Alcoholics are more likely to suffer from gastritis and ulcers.
• liver. Alcohol causes liver tissue necrosis. The destructive process also occurs after a person has stopped drinking alcohol. With alcoholism, patients can suffer from fatty hepatosis and liver cirrhosis.
• genitourinary system. Ethyl alcohol partially settles in the kidneys, accumulates in the sperm and testicles, which reduces reproductive capacity and potency.

The negative effect of alcohol on the central nervous system is manifested in a violation of behavioral reactions

Severity and their signs

Outward signs of alcoholic intoxication depend on the amount of alcohol consumed and the strength of the alcoholic drink. The general state of the human body and the individual characteristics of the perception of alcohol also play an important role in what manifestations can be during alcohol intoxication. Seniors and adolescents are more likely to get drunk from strong drinks.

All signs of intoxication from alcohol are grouped in accordance with the severity of this condition, there are three of them - mild, moderate and severe. In addition, severe poisoning and alcoholic coma are separately distinguished. This classification is based on the indicator of the amount of ethanol in the blood. With a mild degree, it ranges from 20 to 100 mmol / l. To achieve a state of slight intoxication, 2-3 glasses of alcohol are enough.

Its following features are distinguished:

• redness of the skin of the face from a rush of blood;
• increased excitability;
• cardiopalmus;
• distracted attention;
• uncharacteristic vivacity and wit;
• elation and mild euphoria;
• glitter in the eyes;
• blurred look.

Mild intoxication increases libido and appetite. The duration of this state is 3-5 hours, after which the person becomes sleepy and deeply falls asleep. After waking up, there is no hangover and headache... This is due to the fact that a mild degree of intoxication differs more in the psychotropic effect of alcohol than in the toxic one. All the memories of a person about what happened are preserved in full.

The average severity of alcoholic intoxication is characterized by a combination of toxic and intoxication manifestations. Symptoms of disorders of the central nervous system prevail among the signs. The average degree is determined by the presence of ethyl alcohol in the blood from 100 to 250 mmol / l. The following manifestations are observed:

• slurred and slow speech;
• Difficulty finding words;
• inappropriate and impulsive behavior;
• impaired coordination of movements;
• the inability to accurately perform small movements;
• wobbly and unsure gait;
• sweeping and intermittent movements;
• difficulty in external perception;
• impaired orientation.

With such a degree of intoxication, a person's self-esteem unreasonably increases with a sharp decrease in the critical attitude towards oneself. Mood swings are observed, a person may be in a state of euphoria and at the same time sharply show irritability, discontent and resentment. Depressive experiences are again replaced by a feeling of euphoria. After drunkenness, a person falls asleep and after waking up some episodes that took place in a state of intoxication fall out of memory and are forgotten. The next morning, severe intoxication appears, while the efficiency is reduced.

A severe degree of alcohol intoxication is diagnosed when an ethyl alcohol content of 250 to 400 mol / l is found in the blood. In this state, the ability to orientate is almost completely lost and numerous violations of the vital important systems organism. A person is not able to react to people, he is severely inhibited and does not understand what they are talking about, and he himself cannot explain anything.

The intoxication effect is long lasting and lasts for several days.

The characteristic features of this degree are as follows:

• inability to stand independently;
• significant difficulties in speech and facial expressions;
• dizziness;
• complete lack of appetite;
• nausea and vomiting;
• disturbances of consciousness;
• incontinence of urine and feces;
• decrease in body temperature below normal;
• amnesia.

The physical manifestations of this degree of alcoholic intoxication include: severe heart palpitations, lowering blood pressure, increased sweating. With such symptoms, formidable complications can develop. A severe degree of intoxication is dangerous because a person can fall into a coma. This is especially true for those who drank a very large dose of alcohol for the first time.

The degree of intoxication is determined by the amount of alcohol in the blood.

Signs of pathological intoxication

According to the form of manifestation, alcoholic intoxication is divided into:

• to the depressive. The intoxicated person develops an obsession with suicide. In this case, the help of a specialist is required;
• dysphoric. A person in a state of intoxication develops an inexplicable fear and panic, he is suddenly overcome by an irresistible melancholy;
• hysterical. It is more common in women and is characterized by increased conflict;
• hebephrenic. An adult intoxicated begins to behave like a child. At the same time, he shows aggression if you point out this fact to him.

The pathological forms include epileptoid and paranoid alcoholic intoxication. The first is distinguished by sharp drops in prostration and arousal. Its main signs are anger and aggression, inappropriate behavior. At the same time, the consciousness of the intoxicated person is not disturbed. The paranoid form of intoxication differs in that a person develops paranoia, he sees a danger to himself in everything. Gradually, uncontrollable horror seizes him, hallucinations appear.

Also, an alcoholic coma is a severe form of intoxication. It is accompanied by such manifestations as: loss of consciousness, increased pulse rate, constriction of the pupils, severe vomiting. On the background low temperature, sweat appears on the patient's forehead, the skin of the face turns blue. With a deep coma, the pulse and pressure drop to a critical level, all life processes slow down, a person can die.

Alcoholic coma - extreme intoxication

Manifestations necessary for drawing up an act

Alcohol lovers often face difficulties both in everyday life and at work. So, if an employee is confirmed to be drunk at the workplace, then this threatens him with disciplinary action or even dismissal. Drunk drivers are dangerous to others while driving. Therefore, traffic police officers have the right to stop suspicious drivers and check them for the fact of alcoholic intoxication.

This right is clearly stipulated in the law. It is also indicated that when such violators are identified, an act of examination of the state of alcoholic intoxication is drawn up. Identification and testing is carried out on the following points: external symptoms, analysis of exhaled air and blood test for the presence of alcohol. In some cases, it is necessary to take a urine sample to identify residual alcohol metabolites in the body.

Certification of alcoholic intoxication is enshrined in law

The main signs of intoxication are slurred speech, inappropriate behavior, the smell of alcohol when breathing, and a wobbly gait. Therefore, the identification is carried out precisely according to these indicators. In the certificate of inspection, the following columns are filled in:

• Date and place of survey.
• Full name, position and type of subdivision of the person making up the act.
• Information about the person being examined (full name, place of work, date of birth and place of residence, telephone number).
• Signs of drunkenness.
• The exact time of the beginning of the survey.
• The device used for the procedure.
• The percentage of detection of ethyl alcohol in the air exhaled by a person.
• Confirmation or refutation of the fact of alcoholic intoxication.

The examination process should take place in the presence of 2 strangers - attesting witnesses. A copy of the report with the results is handed over to the person in respect of whom the procedure was carried out. At the same time, he must indicate whether or not he agrees with the presented results and sign the document.

The validity of the diagnosis "Alcoholic intoxication" in medical documents

bibliographic description:
The validity of the diagnosis "Alcoholic intoxication" in medical documents / Yankovsky V.E., Kazymov M.A., Tumilovich Ya.V. // Mat. VI All-Russian. Congress of forensic doctors. - M.-Tyumen, 2005.

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/ Yankovsky V.E., Kazymov M.A., Tumilovich Ya.V. // Mat. VI All-Russian. Congress of forensic doctors. - M.-Tyumen, 2005.

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The validity of the diagnosis "Alcoholic intoxication" in medical documents / Yankovsky V.E., Kazymov M.A., Tumilovich Ya.V. // Mat. VI All-Russian. Congress of forensic doctors. - M.-Tyumen, 2005.

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/ Yankovsky V.E., Kazymov M.A., Tumilovich Ya.V. // Mat. VI All-Russian. Congress of forensic doctors. - M.-Tyumen, 2005.

The analysis of "expert opinions", "acts of forensic medical examination of corpses", "acts of forensic medical examinations of living persons" shows that often in the "conclusions" (conclusions) there appears an unreasonable indication of the presence of alcoholic intoxication, borrowed from medical documents, most often from case histories.

This unreasonable conclusion carries with it socio-legal consequences, which can be expressed in a negative solution to the issue of payment of a sheet of temporary disability 1, increased responsibility for management vehicle in a state of alcoholic intoxication (Article 12.8. RF Code of Administrative Offenses, 2004), non-payment of insurance premium (if there is such a clause in the insurance contract), etc.

The diagnosis "Alcoholic intoxication" can be made in accordance with the order of the Ministry of Health of the Russian Federation of July 14, 2003. 308 "On medical examination for the state of intoxication" only after a complete examination of the patient using not only clinical manifestations, but also data from an additional research method, such as a chemical study of blood and urine in chemical laboratories authorized for such studies.

To determine the validity of the diagnosis "alcohol intoxication" in medical documents, we analyzed 200 acts of forensic medical examination of the corpses of persons who died from various reasons, in hospitals in Barnaul, which provide emergency assistance.

Most of the patients were admitted to hospitals in severe and extremely serious conditions, when it was not possible to receive any anamnestic information from them and to identify any clinical manifestations of alcohol intoxication. The only record in the case histories, during the initial examination of the patient, concerned the indication of the smell of alcohol from the mouth. At the same time, for the diagnosis of alcohol intoxication, blood was withdrawn from patients to determine the presence and concentration of ethyl alcohol by chemical research in the forensic chemical laboratory of the KSUZ "AKB SME". Blood from various hospitals of the regional center is sent to the same laboratory. Similar studies are being carried out in 2 more cities of the region - Biysk and Rubtsovsk, where branches of the forensic chemistry department are organized.

In cases of trauma (craniocerebral, severe combined), the diagnosis of "alcohol intoxication" was made in 10 cases and in 8 cases was confirmed by chemical research. In 4 cases, patients trauma departments was diagnosed with Chronic alcoholism. Moreover, these patients were taken to the hospital in an extremely serious coma.

In another group of patients (100), who received assistance at the toxicological center and the center of thermal injuries, the diagnosis of alcohol intoxication was made in 10 cases, and only in one it was not confirmed by a forensic chemical study. At the same time, 24 patients were diagnosed with Chronic alcoholism.

Analyzing the above, we can say that the diagnosis "alcohol intoxication" was made in 10% of cases and only in 1.5% was not confirmed by a forensic chemical study.

Taking material (blood) for forensic chemical research is a medical intervention and, according to Art. 32 "Fundamentals of the legislation of the Russian Federation on the protection of public health" (dated 27.2.2003 No. 29-FZ), the patient (or his legal representative) must give informed voluntary consent to this medical intervention. At the same time, the serious condition of the patient often does not allow obtaining this consent. However, there is a need for the diagnosis of both severe alcohol intoxication itself and the differential diagnosis of a coma of alcoholic or other etiology. This medical intervention is understandable for toxicological departments, but doubtful for trauma departments, where the diagnosis of alcohol intoxication is carried out in violation of the norms of the order of the Ministry of Health of the Russian Federation of July 14, 2003. N 308 "On medical examination for the state of intoxication", which provides for the patient's refusal to undergo examination (including taking blood for chemical research). There was no record of the patient's consent (refusal) found in any case history.

The picture is even more ugly with the diagnosis "Chronic alcoholism", which should be made by a psychiatrist-narcologist, and not by doctors of other specialties.

In addition, we analyzed 84 acts of forensic medical examinations of corpses and examinations of living persons from 6 districts of the Altai Territory. Alcohol intoxication was diagnosed in 51 cases, which amounted to 60.7%. Moreover, in 19 cases this diagnosis was not "confirmed" even by the smell of alcohol from the mouth; in the 32s - this smell was noted. None of them conducted a forensic chemical blood test for the presence and concentration of ethyl alcohol in the blood. In 28 medical documents (33.3%), the doctor of the admission department noted the presence of the smell of alcohol from the mouth, but alcohol intoxication was not included in the clinical diagnosis, which, in fact, is correct.

Thus, the diagnosis of "Alcoholic intoxication" in the medical documents of non-specialized medical institutions is not legitimate: firstly, such a diagnosis should be established in the relevant health care organizations licensed to carry out such medical activities, and secondly, the illegality of taking material for forensic chemical research without the consent of the patient or his legal representative.

In the presence of alcohol intoxication in the final clinical diagnosis, the forensic medical examiner should not in any way evaluate this diagnosis, which should be reflected in the "conclusions (conclusion)".

In cases where there is an act of forensic chemical research in the history of the disease indicating the concentration of ethanol in the blood, the forensic expert must point to the existing document, but at the same time refrain from any interpretation of it.

This problem requires research not only by forensic experts, but by lawyers and sociologists.

1 p. 2.10. Instructions on the procedure for issuing documents certifying the temporary disability of citizens, annex to the order of the Ministry of Health and the Ministry of Health of the Russian Federation dated 10/19/1994. No. 206.