[nutribeat]

What have been your experiences in dealing with patients admitted with full blown DTs? I'm talking about into the psychiatric unit, not ICU or med/surg.

[jmgrn65]

our psych unit doesn't take any medicals so a full blown DT's would go to ICU. because it is a medical problem. Now if your psych takes medical's then it is probably ok as long as you are giving valuim or ativan.

[nutribeat]

Thanks JMG! Our admissions are supposed to be medically cleared/medically stable. We received this patient from ICU on Tues. No valium or ativan ordered, none received when called for. Librium, PO, for an agitated, paranoid, hallucinating person who pulled her own IV out. All docs cleared her for admission. Not sure if the DTs started on ICU or on the way but she sure looked like full blown DTs on arrival.

[Morgan314]

I had a part-time job as CNA while in nursing school, and one night I had a pt who was worried about a spider in his room. He described its appearance and said it was spinning a web from the top of the window. I never saw it, but when he said it dropped to the floor and ran up under the bed, I got down to look for it. The RN saw me crawling on the floor and called me out of the room and told me the man was being treated for DT's and having hallucinations.

[navynurse06]

When I was in nursing school I worked as a Tech in the ICU/PCU at my local VA hospital. Needless to say we had a great deal of pts who where going through DTS from ETOH and drugs. These pts can be very challenging to work with the say the least. They can get very combative and mean; most of the time having to been restrained. I had a pt one time try to kick me in the head with his stump (bka). That was an interesting day at work to say the least. Also, took care of a pt (who was going through dts) one night that some how got of his restraints (posey, and wrist). It took 3 female nurses and 1 male nurse to finally get him back in bed. Well...in the process of getting him back in bed he broke one of the nurses fingers. Not sure how that happen excatly....after he came out of the fog of withdrawing he was the nicest man you could ever meet.
Like I said taking care of pts who are going through DTs are very challenging to work with.

*Just want put a disclaimer on this post...I'm just giving my experiences with pts who have this disease process...I'm not labeling every pt who goes through DTs as "mean" etc...I'm just sharing my experiences...*

[Morgan314]

I worked inpt psych many yrs ago, and our doctor would order valium and also an assortment of vitamins which are important for a person detoxing, but I can't remember why it is crucial for these certain vitamins. my bad.

[Angie O'Plasty, RN]

Mind you, we're a tele/med-surg unit, but we have standing orders for patients who might go into DTs. We use a CIWA scale to assess their level. Detoxing patients can die without the proper treatment. I'm surprised that this patient was not treated medically.

We usually give a Banana bag daily (with things like thiamine and folic acid in it), librium, and valium. Pt is assessed q2h neuro and vitals and graded according to the CIWA scale. If the patient scores high (I think above a 7) they have to be sent to ICU:

http://images2.clinicaltools.com/images/pdf/ciwa-ar.pdf

Here are a couple of other helpful links:

http://www.nlm.nih.gov/medlineplus/e...cle/000766.htm

http://pubs.niaaa.nih.gov/publicatio...22-1/38-43.pdf

[elkpark]

DT is a medical problem, not a psychiatric problem -- everywhere I've ever worked (in my >20 yr. psych career), people with DT were treated in ICU. (I'm talking about real DT here, not ordinary, uncomplicated ETOH withdrawal.) I can't imagine trying to manage DT on a general psych unit!

[nutribeat]

Thanks for your posts everyone! It's a shame there are few detox facilities around, although I know that they are a money loser, I find the work very interersting.