Management of alcohol withdrawal delirium - an evidence-based practice guideline. * Mayo-Smith MF, Beecher LH, Fischer TL, et al. Key Referencesįollowing are the most informative references cited in this paper, as determined by the authors.ġ2. Subscribe for full access to all Tables and Figures. Clinical Pathway for Emergency Department Management of Alcohol Withdrawal Syndrome How would you manage these patients? Subscribe for evidence-based best practices and to discover the outcomes. What are your priorities in the initial diagnosis and management of this patient? He is attempting to sit up in the stretcher and appears to be miming turning a key in a car ignition, repeating over and over, “I have to go.” He is diaphoretic and tremulous. His vital signs are as follows: heart rate, 162 beats/min, and blood pressure, 165/92 mm Hg. You find a disheveled man who appears to be malnourished being restrained by 2 security guards. The paramedics were initially called for seizure-like activity. He has a history of pancreatitis, and his wife told the paramedics that he has complained of abdominal pain and has been vomiting for the past 2 or 3 days. The paramedics tell you he’s a local man with known severe alcohol use disorder. Case PresentationsĪs you consider treatment options, a nurse asks for your assistance in an adjacent room where EMS has brought in a 62-year-old man with agitated delirium. An aggressive frontloading approach with benzodiazepines is presented, and the management of benzodiazepine- resistant disease is addressed. This issue reviews the pathophysiology of alcohol withdrawal syndrome, describes the manifestations of alcohol withdrawal, and examines the available evidence for optimal treatment of alcohol withdrawal. Patients commonly manifest hyperadrenergic signs and symptoms, necessitating admission to the intensive care unit, administration of intravenous sedatives, and frequently, adjunctive pharmacotherapy. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)Īlcohol use disorder is a prevalent medical and psychiatric disease, and consequently, alcohol withdrawal is encountered frequently in the emergency department. Disposition Criteria for Patients With Alcohol Withdrawal Syndrome Signs and Symptoms of Alcohol Withdrawal Syndrome Risk Factors for the Development of Alcohol Withdrawal Differential Diagnoses of Alcohol Withdrawal Syndrome Pharmacologic Properties of Diazepam, Lorazepam, Midazolam, And Chlordiazepoxide
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