AMS

[cbeeny]

recently we have had some cases of patients coming in with AMS, varing underlying causes that have us all scratching our heads in this small town hospital. I sometimes wonder if we would have sent them to a facility that had more specialties available if they would have found something else nuerologically wrong with these patients. One had brain atrophy from ETOH, but yet when admitted his blood alcohol was 21, he had a bout of becoming more unsteady, many falls, yet he still hadn't really change any habits, now he is pretty much doomed to a LTC facility, he can't communicate or take care of himself at all, he had been running his own in home business now no ones home. we had several differnt cases not all related to ETOH.... anyone else see any funky nuero stuff, or maybe some wierd new virus out there. Just courious

[jadelpn, LPN, EMT-B]

Here is the interesting thing about ETOH and chronic use/abuse and what results--a great deal of the danger of ETOH happens as the patient's blood alcohol level DROPS--so in other words, the bad effects of chronic abuse will and do happen when you have someone who lives at an ETOH level of 200 and you see them at 21.

There are withdrawal protocols that help to prevent this from happening. Other thoughts are a patient can and does go into DT's, they can and do have seizures, and the AMS that you are seeing is due to the withdrawal as opposed to the ETOH itself.

This all can be really, really dangerous, and patients can be/become completely non-functioning. I am assuming that you all have withdrawal protocols in place, that you closely monitor these patients, and that they are medicated accordingly? If this is not happening, this is a HUGE issue!

If you are having patients that are not transferred to a detox bed, and you are holding them, now is the time to speak to your manager about reviewing the ETOH withdrawal protocol, that you all are following the same, and that the whole staff is educated on how to manage an actively withdrawing patient.

I would NOT (nor should you be) the nurse who is the one who has a seizing patient that results in a complete loss of function or death, and the patient was not medically managed in their withdrawal. That will come back and bite the NURSE hard.

Yes, I do get that ya'll aren't a detox (and is there social work who actively seeks detox beds for these patients?) and that a patient who has AMS is a challenge. I also get that patients could be in for something completely different, and ETOH is just a complication of this. But a part of most assessments is the patient's use of ETOH (which they may or may not admit to).

Bottom line--since you are seeing a higher number of patients who are having AMS due to chronic ETOH abuse, this can and does become complicated and dangerous. They need to be managed well. And if you do not have policies in place to manage this, now is the time to get some.

Go to your manager with this.

As an aside, there are more and more patients who are taking all sorts of substances--not just ETOH--that can cause some serious withdrawal symptoms. Now is the time to review ALL of the facility guidelines/orders/protocols on substance abuse withdrawal, and come up with a management plan.

[AJJKRN]

Look up Wernickes Enchephalopathy as well all of the malabsorption issues from chronic alcoholism (like lack of thiamine absorption). I want to say to check ammonia levels as well. I can promise spelling mistakes were made while using my phone to text!

[Dranger]

Tons of reasons for AMS:

Urosepsis/sepsis in general

Adrenal issues

Electrolyte imbalances, dehydration, glucose issues etc

Syphilis/herpes

Encephalopathy due to alcohol or liver damage

CNS issues both blockage and damage

Neoplasms

Of course ETOH

The list goes on.....