Just curious to see what type of protocol others are using for their patients that go into acute alcohol withdrawl/ DTs after being admitted to the hospital for another problem.
We do have a withdrawl protocol but many of us feel that it does not work as well as it could. Typically we use IV ativan, PO libirum and add mutlivits, etc to the patient's daily IV fluids- or PO if they are taking it. We are going to talk to our behaviorial health unit and see what protocols they use as well...just getting a feel for the current things others are doing...
Is anyone giving their patients actual alcohol (I ask this because when we get patients going through withdrawl- I am pretty sure that they are not withdrawling by choice...mostly they end up in my unit as an emergent kind of thing and haven't dealt with everything else that goes along with quitting...and we aren't going to make them stop)
I know alcohol withdrawl can be fatal, as I mentioned in my post I believe in helping them through the severe and dangerous physical symptoms so that they don't die but at the same time letting them feel the effects of withdrawl and how powerful the alcohol is. I wouldn't let them die just to let them learn a lesson, I just would let them feel what they have done to themselves so it wouldn't happen again. Is that so much to ask?
What did it for me was after one night of heavy drinking I woke up naked next to the biggest fattest ugliest woman with stretch marks and sores all over her body.
Look at the bright side. At least you didn't wake up married to her.:sofahider
My thinking on one of the posts someone said they used propofol to put them in a kinda rapid detox. Isnt' that defeating the purpose of withdrawl. Sure its an easy way out for the patient but what lesson is learned? Same with any withdrawl. I beleive in medication to a point of helping the severe physical withdrawl that can be dangerous including seizures and vitamin deficiencies or malnutrition. But I also think withdrawl should be very hard on a patient so that maybe they will say "that was the hardest thing I have ever had to go through, I will never ever to that again!"
Just a thought. Curleysue
I am a psych CS who has worked in detox and chemical dependency for many years, and have run into this same thinking many times over the years (usually from non-psych people). In my experience, all that approach does is convince the user that s/he does need to make sure that s/he never goes through that (withdrawal) again, and the best way s/he can think of to do that is to keep drinking steadily ... It seems to be more about punishing the alcoholic for drinking, rather than treating a medical illness (chemical dependency/withdrawal) appropriately. Our job is to offer high quality treatment according to current, accepted standards of practice, not pass moral judgment on people.
I am a psych CS who has worked in detox and chemical dependency for many years, and have run into this same thinking many times over the years (usually from non-psych people). In my experience, all that approach does is convince the user that s/he does need to make sure that s/he never goes through that (withdrawal) again, and the best way s/he can think of to do that is to keep drinking steadily ... It seems to be more about punishing the alcoholic for drinking, rather than treating a medical illness (chemical dependency/withdrawal) appropriately. Our job is to offer high quality treatment according to current, accepted standards of practice, not pass moral judgment on people.
I am a psych CS who has worked in detox and chemical dependency for many years, and have run into this same thinking many times over the years (usually from non-psych people). In my experience, all that approach does is convince the user that s/he does need to make sure that s/he never goes through that (withdrawal) again, and the best way s/he can think of to do that is to keep drinking steadily ... It seems to be more about punishing the alcoholic for drinking, rather than treating a medical illness (chemical dependency/withdrawal) appropriately. Our job is to offer high quality treatment according to current, accepted standards of practice, not pass moral judgment on people.
Its funny how in politics high Family values are such a motivating political factor, you cant be more judgmental than that. We are naturally and genetically designed to be judgemental, it is in our basic makeup of life.
When a alcoholic on a binge drives and has wreck with a family in their SUV and I deal with both family and their losses as well often dealing with the drunk. It is rare I have ever seen a drunk show any caring about the people he has hurt, They are only concerned about themselves, and their legal problems. Doesnt metter that he killed some little girls Daddy. He is only worried about his license.
I know alcohol withdrawl can be fatal, as I mentioned in my post I believe in helping them through the severe and dangerous physical symptoms so that they don't die but at the same time letting them feel the effects of withdrawl and how powerful the alcohol is. I wouldn't let them die just to let them learn a lesson, I just would let them feel what they have done to themselves so it wouldn't happen again. Is that so much to ask?
:angryfire Dang it! I really dislike this high all mighty self serving righteousness that so many nurses have towards ETOH/drug abusers. They are not naughty children that need to be taught a lesson. In most cases they learned their lesson a long time ago or will learn it sooner or later. Will they stop drinking/using? Maybe, most likely not. But with 99.9 % probability it won't be you who will teach them the lesson, Nurse! They are people that made a mistake a long time ago and now they're sick... just like smokers, many obese people, many post accident paras and quads and many others... :angryfire
Specializes in LTC, assisted living, med-surg, psych.
Wow, am I glad I never ended up in the hospital in full-blown DTs with nurses like some of these posters taking "care" of me!! :angryfire All that would have done was convince me (as if I needed further convincing at the time) that I was hopelessly screwed up and might as well just go out and put a bullet in my head.......nothing else.
Luckily I survived my experiences as a drunk, never had DTs, never landed in the hospital with acute ETOH poisoning.......must've been God watching out for me, because I sure as heck wasn't watching out for myself. I've been sober over 13 years now, and everytime I see someone admitted for detox I think "there, but for the grace of God, go I". I don't like dealing with people in the throes of DTs any better than anyone else, but nowadays we're doing more of these detoxifications in the critical-care unit under sedation, and I think that's the most humane way to get people through the rough parts. You're not going to 'teach someone a lesson' by allowing them to experience the full effect of DTs, and they could even die.........are any of these posters willing to take that chance, I wonder?
I don't think the ER is the place for anyone to be who is going through ETOH withdrawal, but like mental health clients, they end up there because often there is nowhere else for them to go. It's meant for medical emergencies the staff is trained for, not detox. It's kind of like when the ocasional baby is born in the ER; it happens, but what a fiasco! That's because pregnant women are best cared for by OB nurses who understand the specialty.
Furthermore, I can see why the ER nurse wouldn't have any compassion for the drunk driver in the ER that was responsible for the death of the innocent man in the next cubicle; too much to ask of anyone to reserve judgement in a case like that. Have to be a saint to be able to rationally handle a situation like that. Caring for those in alcohol withdrawal requires specialized care providers who are trained to best care for these patients. In a perfect world...
Thanks for your response...While I don't know exactly what the CIWA scale stands for...we use a protocol similar to what you have mentioned...with the B Vits/ lots of ativan as needed/ and the librium...It was just a bad combo all together but we all realize that we need to bone up on the current care for this type of patient....
You're not going to 'teach someone a lesson' by allowing them to experience the full effect of DTs, and they could even die.........are any of these posters willing to take that chance, I wonder?
Alcoholism is such a tragic disease! It has many more victims than the abuser.
Alcoholism is such a tragic disease! It has many more victims than the abuser.
Thank you! My father just died from alcoholism....well alcoholic cirrhosis. Did I like the disease/ addiction? No! But it is an addiction and he did try to fight it...but just because we don't like how someone got sick, doesn't mean we have to care for them any different than any other sick people or let them "feel" DTs etc to teach them a lesson.....Heck...I don't like smoking, but take care of quite a few COPDers, lung Ca etc and I've never withheld or waited on giving a breathing treatment or given care any different...it is none of our business...Taking care of patients is our business. Yes we can try to educate and reinforce good heath behaviors, but you cannot force a person clean!
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curleysue
100 Posts
RMNI2004-
I know alcohol withdrawl can be fatal, as I mentioned in my post I believe in helping them through the severe and dangerous physical symptoms so that they don't die but at the same time letting them feel the effects of withdrawl and how powerful the alcohol is. I wouldn't let them die just to let them learn a lesson, I just would let them feel what they have done to themselves so it wouldn't happen again. Is that so much to ask?