Hi! I work night time at a medical ward and lately have received a lot of intox patients. My colleague who tonight was working on the opposite ward (we are 1 nurse plus 1 tech per ward) received an alcoholic who'd been on a binge. I asked about delirium earlier during the night to check what was going on and they did have quite a lot to do with the patient who was agitated but they didn't mention it.
Forward four hours and they call me to see if tech on my ward could help out, after 20 minutes alarm goes off and patient is in cardiac arrest. I run to help and get the impression patient had had a 40 degree Celsius fever, hallucinations, agitation, cramps and basically all symptoms of DT. Suddenly asystole so no defibrillation went off. It left a sad feeling in my gut, how quickly have you seen delirium tremens develop? Was quite a young person. I have personally never seen DT. The ER doctor must've noticed something off but still put patient on the ward instead of ICU, shouldn't it be treated in ICU generally? My colleague must've given the doctor feedback during the night of condition.
Week before had unclear intox who also arrested but lived. Doesn't feel very good to receive patients who are this ill and can survive with ICU care.
Lab work is standard at the ER. As well as ecg. So I'm certain they did it. As I said not heard of that alcohol protocol though and I'm certain the doctor did not give such instructors to the nurse.
Yeah, acronyms can be a bit confusing for the swede here. We got our swedish versions :-) thanks for explaining. How many different levels of care do you have where you work/patient load per nurse on the different units? Curious about that, sounds like we have quite different system here. Surgery/ortho/oncology/medical units all have this heavy load.
At many hospitals in the states, they have an alcohol protocol that anyone with a known dependency is placed on.
It also includes seizure and respiratory precautions. It is very rare that we have patient with full-blown DTs.
I believe the max on IV lorazepam is 24 mg in 24 hours due to propylene glycol toxicity which also causes severe confusion.
( It's the liquid used to de-ice airplanes).
Precedex can cause dangerous bradycardia and hypotension with the higher doses. They must be monitored.
I have seen immediate relief of agitation in severe Dts with Geodon 20mg IM followed by 10 mg IM q 6 prn. Haldol is not nearly as effective.
It is interesting how other countries regard the disease of alcohol dependence. Some countries don't admit patients for detox at all. In Switzerland, beer is on tap in the cafeteria as well as individual bottles of wine. Patients are allowed a serving of either one at lunch, dinner and at bedtime. Maybe teaching moderation is good management for some people. The prison system there issues one marijuana cigarette a day to the inmates. They report hardly any violent events.
I worked at a hospital in the States that sent a small bottle of vodka on the tray if the patient admitted to regular alcohol consumption. I am sure that this helped some people.
We need to be asking "do you intend to stop drinking when you leave this hospital?" If the patient says no, then we should not put them through a life threatening period of detox if at all possible.
We need to be asking "do you intend to stop drinking when you leave this hospital?" If the patient says no, then we should not put them through a life threatening period of detox if at all possible.
I think you have brought up a point that deserves much consideration.
I believe the max on IV lorazepam is 24 mg in 24 hours due to propylene glycol toxicity which also causes severe confusion.
( It's the liquid used to de-ice airplanes).
It's also added to various foods and beverages as both a preservative and "texture enhancer", such as with ice cream. Polypropylene glycol is very similar, which is what miralax and Go-lytely is.
We use 50mg/24 hours or 500mg diazepam/24 hours and the amounts to try and avoid, luckily the development of propylene glycol toxicity can be monitored through basic labs.
I worked at a hospital in the States that sent a small bottle of vodka on the tray if the patient admitted to regular alcohol consumption. I am sure that this helped some people.
We need to be asking "do you intend to stop drinking when you leave this hospital?" If the patient says no, then we should not put them through a life threatening period of detox if at all possible.
This seems to be coming full circle. There's a picture hanging in my hospital of a nurse (back in the day) pushing the 5 o'clock "drinks cart" from patient to patient, which as pretty clearly an impressively well stocked full bar on wheels. Men's meal trays typically came with a beer.
Then we apparently decided that was poor form, we shouldn't be enabling patients' poor health habits, potentially harming them.
I think we're now starting to realize that in many instances it's far more the lack of alcohol that is going to cause harm. Our open heart physicians starting bringing their patients beer and/or hard alcohol when they went into withdrawal after surgery, and now our cafeteria stocks beer which a doc can order to come on their trays. We even have a couple of docs that order IV alcohol for patients in withdrawal (and no intention to quite on discharge) who can't take PO.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
You need to speak with TPTB in your hospital for spelled out guidelines. If we have a patient detoxing from alcohol on our Med/Surg specialty floor they must not require over 16mg of IV Lorazepam within 24 hours. If they do, they are immediately shipped out to a higher level of care. We use a computer tool that takes the patient's symptoms/vital signs and assigns them a number. According to the number, the tool will show us how much Lorazepam to give and when to reassess on the tool.
This is something (DTs) that is preventable. Our hospital had a team of Behavioral Health Nurses that educated all staff on prevention. The patients were screened and a simple symptom scale used with scores that would indicate when meds were needed to prevent DTs from happening. If interested, I can give more info. It did help save lives and helped the nurses not have to deal with symptoms that are time consuming and preventable!
Jory, MSN, APRN, CNM
1,486 Posts
At many hospitals in the states, they have an alcohol protocol that anyone with a known dependency is placed on.
It also includes seizure and respiratory precautions. It is very rare that we have patient with full-blown DTs.