Is this patient suicidal?

[ceecel.dee]

Patient admitted with blood ETOH .8, unresponsive progresses to need for intubation/ventilation......for the 3rd time in 2 weeks!

Doctor was asked for 72 hour hold and direct transfer to detox with inpatient treatment to follow upon patients stablization. He "could understand how this overindulgence could easily happen with someone who is truely an alcoholic used to drinking huge quantities" (whiskey is poison of choice). When asked when this might be considered a suicidal gesture, he responds, "I hate to antagonize him and he will do much better in treatment if it's voluntary".

This topic is under much debate (he has been with us for more than a week now) and I wonder how this is viewed in other places. We have more leaning toward suicidal gesture requiring mandatory intervention than a mistake. What's your take?

[teeituptom, BSN, RN]

Howdy yall

from deep in the heat of texas

Zumalong, I understand your pain in regards to this. Bur one thing, I have never seen depressed patients get treated like crap in any er, except when their behaviour mandated it. Such as combativeness and other untoward behaviours.

And Xena, have you ever followed up on 72 hour hold patients. Most are turned loose in the morning once they have chilled out or sobered up. Only a small percentage actually make the full 72 hours and even a smaller percentage end up under court ordered hospitalization. Largely due to lack of funding and space availability. I have sat on a mental health review board. Its sad what goes on once they are out of the ER.

And Joenp alcoholics do not drink because they are depressed. They drink because they are alcoholics, study the disease process for alcoholism. Or attend some AA meetings. I am an alcoholic, been there.

[KarafromPhilly]

Zumalong, I'm so sorry for you loss, or rather losses. I think your brothers would be proud that you are able to do this badly-needed educating about the disease that took them both.

((((hugs))))

[KarafromPhilly]

Tom, some people who wind up alcoholics started drinking because they were depressed. And some who didn't start out depressed wind up there after heavy alcohol use. Depression and substance abuse, particularly alcohol, are closely linked (even if it doesn't say so in the Big Book). I am an alcoholic who suffers from depression, so ha ha on you, Mr. Smarty Pants.

[shawng007]

this is a sign that the pt is suicidal, or that he really doesnt care. as a recovering alcoholic, i remember several times being taken to the er with high bac, feeling like nothing mattered anymore. the key here is what kind of feedback is there from the pt. did he just party too much, or is this a sign that he truely is asking for help. often we find ourselves asking for help without saying a word. our actions speak loudly enough. after several times being there for the same thing, he should be held for treatment. often we alcoholics don't realize what we are doing or saying until we have enough time for the haze to lift. once things are clear, someone should have a nice long talk with pt to determine exactly what is going on both within and on the outside. just because someone drinks too much doesnt always mean he is an alcoholic, but it could be an indicator. most will always shun detox and rehab idea also, think they dont have a problem and/or can do it on their own. the truth is, i couldnt do it on my own, not without the help of counselors and AA/NA. this man definitely needs help, and unless intervention is made, he may keep coming back, or he may very well end up dead. antagonize him if necessary, it may save his life.

[Level2Trauma]

Nurse Ratched said, " May not have sense enough to know when to quit (or less sense than average!)"

Alcoholism, or any addiction for that matter has nothing at all to do with the person's intellectual capacity... If this is the attitude you have toward those who suffer from the disease of addicition...I'm sure your patients are pleased to have you as their nurse.

It was just one drink

How was I to know

it would swallow me whole?

The followiing is a list of some alcoholics:(What type of nursing care would you have provided them with?)

Sinclair Lewis

Edgar Allen Poe

Larry Hagman>

Al Unser Jr.

Don Johnson

John Daly

Dylan Thomas

F. Scott Fitzgerald

Jim Thorpe (just to name a few)

Just so there is no misinterpretation, I included the following definition of Alcoholism as stated by the National Council on Alcoholism and Drug Dependence:

Definition of Alcoholism

"Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial."

"Primary" refers to the nature of alcoholism as a disease entity in addition to and separate from other pathophysiologic states which may be associated with it.

"Primary" suggests that alcoholism, as an addiction, is not a symptom of an underlying disease state.

"Disease" means an involuntary disability. It represents the sum of the abnormal phenomena displayed by a group of individuals. These phenomena are associated with a specified common set of characteristics by which these individuals differ from the norm, and which places them at a disadvantage.

"Often progressive and fatal" means that the disease persists over time and that physical, emotional, and social changes are often cumulative and may progress as drinking continues. Alcoholism causes premature death through overdose, organic complications involving the brain, liver, heart and many other organs, and by contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.

"Impaired control" means the inability to limit alcohol use or to consistently limit on any drinking occasion the duration of the episode, the quantity consumed, and/or the behavioral consequences of drinking.

"Preoccupation" in association with alcohol use indicates excessive, focused attention given to the drug alcohol, its effects, and/or its use. The relative value thus assigned to alcohol by the individual often leads to a diversion of energies away from important life concerns.

"Adverse consequences" are alcohol-related problems or impairments in such areas as: physical health (e.g., alcohol withdrawal syndromes, liver disease, gastritis, anemia, neurological disorders); psychological functioning (e.g., impairments in cognition, changes in mood and behavior); interpersonal functioning (e.g., marital problems and child abuse, impaired social relationships); occupational functioning (e.g., scholastic or job problems); and legal, financial, or spiritual problems.

"Denial" is used here not only in the psychoanalytic sense of a single psychological defense mechanism disavowing the significance of events, but more broadly to include a range of psychological maneuvers designed to reduce awareness of the fact that alcohol use is the cause of an individual's problems rather than a solution to those problems. Denial becomes an integral part of the disease and a major obstacle to recovery.

Rolly Helmsley

And yes, I am a recovering alcoholic with 9 years sobriety and have just completed my MSN, FNP degree. I hope to work with alcoholics and show them that we "DO" recover in spite of biased attitudes.

[teeituptom, BSN, RN]

Howdy yall

from deep in the heat of texas

I would have been nice to john daly, maybe he would have taught me how to hit those monster drives of his.

And I am now doing my 27th year of sobriety,and I was the worst kind of alcoholic back then.

[JailRN]

In our 5150 training, (72 hr hold and such) we are taught, and it had been my experience, that if a patient commits voluntarily, it is better for him, but that if not, write the darn hold. We also try to work with the paramedics and get them to realize alcoholism is a disease, not a crime. (Unless it's a DUI or the like) but instead, our jails are cluttered with people whos only crime is addiction to alcohol. It's a tough call. Good luck

[Nurse Ratched, RN]

I apologize for offending by using the term "sense." I should have said "control." As was pointed out, the nature of addiction is the inability to control it. However, those who have posted about their ongoing and hard-fought sobriety are testament to the fact that ultimately the person who wants their sobriety enough (or more than they want the next drink) can have it.

Tom, you asked about the 72 hour holds. On my unit, most of our hold patients do stay the entire time (and all the holds in our facilty come to our unit.) It's up to our doc, of course. I can guarantee that under the circumstances described in the original post, however, such a patient would not be cut loose a fourth time to nearly kill himself again, whether or not the intent was there to do so. He lacks the "sense" or "control" or whatever you want to call it to not drink to a .8 BAC. Now, we can debate whether or not it's up to the patient to make those bad decisions (it is.) But, if he's going to do this and keep getting admitted to the hospital, it's negligent on the part of the doc to allow the patient to leave unfettered when there is a reasonable probability the scenario is going to play out again. If a patient stated he was going to blow his brains out as soon as he got home, we'd slap a hold on him. This isn't much different in my mind.

Again, apologies for any assuredly unintentional offense.

[Level2Trauma]

Nurse Ratched,

Juding form your post....You either lack the "sense" or control or whatever you want to call it, to control your tongue. Don't apologize in one sentence and then repeat the same offensive statement in the next paragraph. Just my opinion.

[teeituptom, BSN, RN]

Howdy yall

from deep in the heat of texas

No offense taken,

But ya got to remember this is Texas, and the texas mental health sytem is overworked underpaid and understaffed. Texas one of the richest states in the union has one of the worst records for mental health care availability in the country, Partially thanks due to george w bush when he was governor. He actually made things worse here. But easily 80 percent of the 72 hour holds my ER sends up, are released the next day after an interview with the psychiatrist. And down here it is almost impossible to commit anyone for substance abuse, no matter how flagrant the situation is. That is reserved for the succidal ideations attempts and the occasional homocidal pt. But rarely a substance abuser. In fact in 15 yrs in this ER, I have only seen 2 or 3 substance abusers committed for 72 hr holds. And there was more to them than substance abuse. One was an addict to heroin and had infected abscesses all over his body.

So Im not really disagreeing with ya nurse ratched aka XENA

but discussing the realities of a piss poor mental health system here in texas.

[OrthoNutter]

Originally posted by canoehead

You guys are real crapheads. There are lots of suicide gestures that should be dumped back out on the sidewalk but is there any compassion for the truly depressed? It's the "suicide- getting it right"attitude that keep the people that need and deserve help from going out and getting it.

The quote was intended to be somewhat of a joke but the underlying sentiment is there alright. Why, because our mental health scheme over here is just too ridiculous to be believed.

People who are actively suicidal in this country do not get the help they need WHEN they need it. Our psych people always wait till it's too late to get through to them. I agree it's a big problem and if my sense of humour is a little too much for a touchy topic then that's just too bad. You know what they say, you can please some of the people some of the time but you can't please them all, so why bother trying to please anyone.

Yours sincerely

No. 1 Craphead

[OrthoNutter]

Originally posted by teeituptom

So Im not really disagreeing with ya nurse ratched aka XENA

but discussing the realities of a piss poor mental health system here in texas.

Not just in Texas....I think the piss poor mental health model of care is infectious! I suffer from depression, that is purely related to work, according to the shrink I saw. His best advice to me was to get out of this kind of work and my problem would go away. Nice thought but having no job doesn't pay the bills. A few years ago, I tried to hack into my wrists with a knife but didn't have the balls to make more than a few nicks and scratches, despite all the dutch courage in the world. Went back to the shrink and said that I thought I had some real problems. And he said and I quote, the fact that I didn't follow through with the idea means that I still have enough sense to realise that what I was going to do would be a really stupid mistake. He gave me the same advice, get out of your job or start making moves to get out so you can see the light at the end of the tunnel. He gave me a script for an antidepressant and now Zoloft is my best friend - quite amazing considering I'm a supporter of the 'meds don't solve everything' belief. I still feel depressed every now and then, particularly when I'm on nights but I just do my best to ignore it and try to keep my sense of humour, which is not always appropriate - that much, I'm willing to concede.