Patient Presentation
True or False: patients can experience withdrawal signs and symptoms with an elevated blood alcohol level...
True
Differential diagnoses include...
drug overdose
trauma
infection
metabolic derangements
hepatic failure
In alcohol withdrawal, the most important element is the prevention of (2)...
Seizures and Delirium Tremens
A CIWA score of less than __ indicates no necessary intervention...
8
The time range in which the administration of N-acetylcysteine most beneficial...
The first 12 hours after ingestion; 150 mg/kg IV over 24 hours
Common vital signs...
Tachycardia
Hypertension
Tachypnea
Hyperthermia
An important metric to measure on an ECG prior to initiation of EtOH withdrawal treatment...
QTc
Symptom-triggered approach often chosen over a fixed-dose benzodiazepine taper...
CIWA - labor intensive scoring system widely used at the bedside
The number of items to be scored on a CIWA scale
10
Salicylate toxicity should be considered in all patients with this acid-base derangement...
Elevated anion gap metabolic acidosis
Define the term... delirium, agitation, tachycardia, hypertension, fever, diaphoresis
Delirium tremens: clinical manifestations of severe withdrawal (differentiate from alcoholic hallucinosis)
Typical laboratory analysis includes...
CBC with differential
Comprehensive metabolic panel
Transaminases
Amylase or Lipase
Urinalysis and urine drug
List 3 medications all patients in alcohol withdrawal should receive...
Thiamine before glucose (extra credit - why?)
Folate
Multivitamins
Intravenous hydration
Electrolyte replacement (extra credit - most common?)
Amount of Ativan given for a CIWA score 13
<7 - none
8-12: 0.5 mg IV; 1 mg PO
13-16: 1 mg IV; 2 mg PO
17-20: 1.5 mg IV; 3 mg PO
21+: 2 mg IV; 4 mg PO
The reversal agent for benzodiazepine overdose AND the most important adverse effect of its administration is...
Flumazenil (Romazecon); seizures
The most common form of hallucination...
Visual
EMS drops off a patient who was found alert, intoxicated, but on the ground outside his local bar. What specific test is absolutely necessary to rule out a potentially fatal or debilitating differential...
CT head non-contrast to rule out ICH/SDH
The benefits of a short-acting over long-acting benzodiazepine include...
Available parenteral
Short half-life allows for rapid titration
Benefit of CIWA over fixed-dose taper...
Possible reduction in the amount of benzodiazepines administered (after 3 consecutive q1h negative scores, transition to q4h assessments)
Pupillary assessment with opioid overdose...
Pinpoint
List 3 characteristics of Wernicke-Korsakoff Syndrome...
Encephalopathy
Oculomotor dysfunction
Gait ataxia
The main inhibitory and excitatory neurotransmitters implicated in chronic EtOH intoxication and withdrawal are...
GABA & Glutamate
List 3 anticonvulsant medications that can be used in conjunction with benzodiazepines or as stand alone therapy...
Carbamazepine
Gabapentin
Valproic Acid
You all have and will order the CIWA protocol. How many of you have used the clinical tool at the bedside and scored a patient?
Technique of drug delivery where illicit drugs are ingested by wrapping the drug of choice in a covering, which then will dissolve in the gastrointestinal tract, thereby releasing the drug for absorption. Can entail crushing of a pill prior to packaging to theoretically increase the surface area for absorption or may involve the packaging of a higher than usual dose of a drug in attempts to attain a sustained-release effect.
Parachuting