A rational approach to the treatment of alcohol withdrawal in the ED

Stehman, Christine R.; Mycyk, Mark B.

doi:10.1016/j.ajem.2012.12.029

Cited by 34 publications

(33 citation statements)

References 111 publications

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“…Additionally, when this patient presented to the ER, the patient did not have hypertension, tachypnea, or tachycardia that you would expect to see in alcohol withdrawal. This patient also did not progress to severe stages of alcohol withdrawal such as hallucinations, disorientation, psychosis, or seizures, which you would expect to, see 7 to 48 hours after the patient's last drink [8].…”

Section: Discussionmentioning

confidence: 99%

“…It is important to note that two to six hours after a person has ceased alcohol consumption, he/she will start to exhibit signs of withdrawal such as nausea, vomiting, diaphoresis, tremulousness, as well as tachycardia, hypertension and tachypnea [8]. These symptoms can be aborted by the administration of IV benzodiazepine, which will start to take affect within hours from the first dose [8]. This patient was given diazepam on day 1, which had little to no effect on his symptoms.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Manifestations of Pregabalin Withdrawal

Àlex¹,

Hamlyn²,

Foo³

et al. 2017

J Psychiatry

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Manifestations of Pregabalin Withdrawal

Àlex¹,

Hamlyn²,

Foo³

et al. 2017

J Psychiatry

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“…The mortality related to alcohol withdrawal syndrome reaches about 8% [19]. Generalized tonic-clonic seizures occur in 3 to 10% of individuals in alcohol withdrawal [5,20]. Focal seizures related to alcohol consumption are also reported (up to 24% in the alcohol related seizures group reported by Earnest and Yarnell) with an other underlying etiology in some of them (up to 15% in the same series) [21][22][23].…”

Section: Alcohol and Central Nervous System From Chronic Alcohol Intmentioning

confidence: 99%

“…In the case of unplanned or spontaneous withdrawal and according to the severity of the latter, oral or intravenous BZD are used as first choice, eventually associated with phenobarbital (PB) or propofol in most severe cases [20]. Indeed, PB enhances both the binding of GABA and the binding of BZD to the GABAa receptors, promoting the BZD effect.…”

Section: Alcohol and Central Nervous System From Chronic Alcohol Intmentioning

confidence: 99%

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The Relationship between Alcohol and Seizures: An Overview of the Major Data

Visee¹

2015

Int J Neurorehabilitation Eng

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Evaluation of a Web‐based Educational Program to Teach the Identification and Management of Alcohol Withdrawal in the Emergency Department

Thompson

McLeod

Perelman

et al. 2018

AEM Education and Training

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Background: Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom-driven approach, where patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol-Revised [CIWA-Ar]) and treated according to severity. Accurate administration of the CIWA-Ar requires experience, yet there is no training program to teach this competency. The objective of this study was to develop and evaluate a curriculum to teach clinicians how to accurately assess and treat AWS.Methods: This was a three-phase education program consisting of a series of e-learning modules containing core competency material, an in-person seminar to orient learners to high-fidelity simulation, and a summative evaluation in an objective structured clinical examination setting using a standardized patient. To determine the impact of the AWS curriculum, we recorded how often the CIWA-Ar was appropriately applied in the emergency department (ED) before and after training. A CIWA-Ar protocol breach was defined as inappropriate administration of benzodiazepines (CIWA-Ar < 10) and failure to administer benzodiazepines when required (CIWA-Ar ≥ 10). ED length of stay, amount of benzodiazepines administered in the ED, discharge prescriptions, and unit doses (takeaway bottle of four tablets) of benzodiazepine given were recorded.Results: Seventy-four ED nurses completed the curriculum over an 8-week period. In the 5 months prior to the educational program delivery, we identified 144 of 565 (25.5%) CIWA-Ar protocol breaches, compared to 64 of 547 (11.7%) in the 5 months after training (Δ13.8%, 95% confidence interval [CI] = 9.3%-18.3%). Program completion resulted in a reduction in the median total dose of diazepam administered in the ED (40 mg vs. 30 mg, Δ10 mg, 95% CI = 0-20 mg) and no change was detected in ED length of stay and benzodiazepines prescribed.Conclusions: Completion of this curriculum resulted in better compliance with the CIWA-Ar protocol by those who administer the CIWA-Ar; however, changes in inappropriate benzodiazepine prescribing practice will require future interdisciplinary initiatives.

show abstract

A rational approach to the treatment of alcohol withdrawal in the ED

Cited by 34 publications

References 111 publications

Manifestations of Pregabalin Withdrawal

Manifestations of Pregabalin Withdrawal

The Relationship between Alcohol and Seizures: An Overview of the Major Data

Evaluation of a Web‐based Educational Program to Teach the Identification and Management of Alcohol Withdrawal in the Emergency Department

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