Here is a link to an article from Advance for Nurses magazine, that addresses technique in obtaining a bp, but the reason I send it is that number 1 reason for an inaccurate reading is wrong cuff size. EVERY unit should have a minimum or 3 sizes, these are not expensive items.
AND, the usual 1st 2 signs of alcohol withdrawal are increased, BP and pulse. I personally hate the CIWA thing-to me it's looking for DT's, vs. early signs of WD.
As for disturbing the MD, TOO BAD!! I always go back to the "what would I say in a court of law, if I had to defend my actions?
Attorney: "nurse, when you saw the patients BP was 199/110, did you call the doctor?"
Attorney: "Why not? Didn't you know that was elevated?"
Nurse: "well I knew it was out of the normal range, and it was elevated for this particular patient from the shift prior. BUT, I didn't want to disturb the doctor" Can you imagine saying that? Well, then don't do it.
As for the tachycardia and low bp, push fluid, sounds a lot like dehydration, esp as you mention the pt. is paranoid..probably afraid to eat or drink. Try 16+ ounces water and check again in 30-60 mins. You'd be amazed how often this is the case!