Alcohol Intoxication.

Virgo_RN, BSN, RN · Mar 14, 2009

Our AWD protocol uses Ativan PRN according the Riker Sedation-Agitation Scale.

I'm not aware of any new research, but my pharmacology text states that administering other benzos with short half lives such as Librium on a fixed schedule is an effective treatment strategy, but that using PRN medication according to symptoms permits a quicker withdrawal.

tutored · Mar 14, 2009

In my unit (ICU) it's the librium-only Q4, then Q6, just to start, with a PRN benzo Q2 if the patient is a huge drinker, OR if there's a neuro-thing going on like a cranial bleed, where they want to REALLY keep them calm, then there may even be a benzo drip at 1 mg/hr for the first 24 hours ALONG with the librium, but this is the most extreme medicating I've seen. Librium seems pretty lame on it's own, anyone else agree???

cardiacRN2006, ADN, RN · Mar 14, 2009

Be sure to use a full CIWA-- meaning with ortho BPs....we get patients who were on CIWAs in med ER and for some reason their CIWA sheets don't include the Ortho BPs.

Our CIWA doesnt' have orthostatic BPs (THANK GOD)

I am usually doing everything I can to keep these guys in bed (even WITH restraints), so I am so, incredibly grateful, that BPs in not in ours!

Our CIWA protocol is good, and we end up dosing Q1hr anyway...

Chewie_123 · Mar 14, 2009

My hospital uses the CIWA protocol for detox. Uses a series of assessment scores to determine the hourly dosing of PO valium or IV ativan. Have never used librium for detox... Research time!

BrnEyedGirl, BSN, MSN, RN, APRN · Mar 15, 2009

We use CIWA,..years ago Librium was used alot, we mostly use ativan now. It really depends on the pt. I've started ativan gtts on the really bad ones!

allnurses Guide · Mar 15, 2009

We do CIWA here as well. Its so commonly ( ) needed that I think our medsurg nurses can cite it from memory. No orthos here either. Our ER docs tend to be liberal with the Haldol and Ativan until we can get folks to the floor.

rwal2222 · May 7, 2009

I'm so glad I found this website. Here is my question:

Is it ok to give an intoxicated patient Libruim? Our hospital has done this since I started working here, and all the literature I've read says it is absolutely NOT ok to do this. We have patients that come to our ward straight from the streets. Last week a patient had a BAL of 348, and our psychiartrist ordered 25mg of Libruim for him and he recieved it within an hour of arrival, with qid routine thereafter. I could not believe it! I have seen too many patients go into respiratory arrest by this practice, however, I'm seeing it done more and more. And its not just psych wards, but ER's and ICUs doing it as well. Although they do have the means to intubate, its still a very dangerous practice.

Has anyone had this happen to one of their patients?

Thanks

EarthChild1130 · May 8, 2009

On one unit I worked, we used Librium q4h, and standing orders that were something like check BP q4h and if BP is greater than 140/90, give Librium (or some such order)...on another unit we used CIWA, and I found that CIWA is a much better assessment tool...it gives a better insight into the patient's actual condition and provides more in-depth feedback into his/her condition and symptoms.

We never had patients on the locked unit with BAL over, I think, 100...if they came in intoxicated, we had a psych ER that would hold and monitor them till their BAL was at a level that permitted admittance to the unit.

blueheaven · May 9, 2009

One hospital I worked at had a protocol based on the symptoms a pt was having at the time. This meant that you had to assess frequently q2h initially but the librium or ativan amount was based on the scoring of the tool. We very rarely had anyone who required mechanical ventilation for ETOH withdrawal.