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The doc can order ativan evry two hours. It won't kill the patient.

How long should it take for the Ativan to kick in?  I felt so bad for this lady because she didn't know where she was or who I was.  Just an hour before she was thanking me for helping her.  It was as if she was experiencing something bad that had happened to her before and the RN and I were people other than who we were.  We just kept the EKG wires off her and tried to get her O2 sats whenever she would let us.  I just stood there with my hands in my pockets and listened. It was my first experience seeing someone going through withdrawal and I never realized how bad it can be for them.  Thanks for the input.  I am so thankful for all of you.  It really helps me see things from different points of view.

Thanks CD,  I'll so some research

snowbunnyRN says ...

In regards to an Alcohol Withdrawal Protocol that had been suggested by CD Nurse, the facility that I work in is formulating one at the present time to be in effect in the near future.  At this time , we are relying on individual MD's orders .  However, I am seeing many of our MD's ordering Ativan Q 1 Hr instead of Q 2 hr in IV route - not PO. It seems to work fairly well.  The key to it's success is early recognition of an alcohol problem  on admission of the pt. to get the Ativan 'on board' .  With early intervention, initiating the Ativan at 1st signs of withdrawal --  this seems to be the key to having some control over the combative and other behaviors that a person would exhibit.  Hope this helps.

Thanks for the info.  This situation has really made me want to learn more about this disease.  We are getting more and more patients coming through with alcohol withdrawal.  We aren't equipped up in mental health to take care of them so they go down to ICU.  I think there is a protocol in place and this particular patient had already been through several days of taking Ativan.  There aren't many local substance abuse facilities in our area.  The closest one is always full.  They only accept insurance or people who can pay their $15,000.00 fee.  Most of the people coming through our facility don't have insurance or are court-ordered to be there.  It's a good thing we are a not-for-profit hospital or most of these people wouldn't be getting the care they need.

kendbeef says ...

Does anyone out there have any good advice on how you provide cares for a patient going through ETOH withdrawal and combatitive.  This patient was hallucinating, pulling off EKG lines, O2, trying to pull out IV line and cath.  Pt was hitting us and I was called every name under the sun and threatened.  I know the pt won't remember it....earlier pt was very nice and then BOOM she was out there!  Dr. restarted the Ativan but after an hour and a half it wasn't making a dent in the behavior.  I didn't take any of it personally, I just wish I understood it better so that I could provide care in a positive way and keep myself safe. 

I work on a unit where we frequently get pts in etoh withdrawal, When they are that far gone, and not responding to the ativan, they need ICU. They can be intubated and knocked right out for a few days, which in many cases is what they need. At the hospital I work at we have an Ativan Protocol, this is a tool we use to score a pt, and medicate according the how high they score. At first they are being scored every half hour, and medicated with anywhere from .5mg to 4 mg of ativan IV, and also recieving up to 2 to 4 mg every 4 hours atc. I used to work in ICU. I once had a pt who was getting 20mgs of ativan every hour, with a prn of 10 mgs every half hour. He was stilll awake and talking to me.

 Never be afraid to get an icu consult.

Years ago they fought fire with fire.  They would give them small doses of alcohol, and gradually taper them off.

I guess I still just don't understand this concept. How much does a person have to drink to go through something like that? I don't get it. Because unless they drink 24/7 wouldn't they go through some sort of withdrawl everyday when they stop drinking?

Also one more question if someone would please answer for me. At my work we admitted a 55 yr old man who seems kinda "slow" for lack of a better word. How much alcohol does it take to make your brain fry that much and be basicly unable to care for yourself? I can't imagine how they do this!

I was surprised no one mentioned a shot of B12,clonodine,dilantin and as much gaterade as they can drink. For the amount of people we had put on a etoh detox protocol, we had maybe one of 70 pts go to that extreme. If they did come in that bad it was off to a local hospital.Nip it in the bud nurses. Evaluate hand tremors,diaphoresis and vital signs q 4 hrs. Get a etoh detox protocol by an experienced doctor or nurse.Clonodine also has a sedative effect. A multi vitamin daily. At least 3 bottles of gaterade or more a day. Have prn's in your protocol for G.I upset. Get them out of bed and socializing to limit anxiety. There is so much more that I recommend calling a rehab that detoxes for more information. Good Luck and nib it in the bud and things will be so much easier on you as well as the patient.

this is such a hard disease to treat.  I agree with the Ativan q 2 hours.  It is a great drugs and really helps with the anxiety.  However, getting off the bottle is something that no one can understand like the patient.  Withdrawals must be aweful.  It takes a patient, kind, caring nurse to deal with these patients.  If you need a break, or it is getting out of control ask another nurse to step in for a bit.  Sometimes just taking time to breath and removing yourself from the situation for a little bit can help you jump back in the game.  Good luck to you!

I am sorry, I did not read all the posts but I worked with an addictionologist, MD for years on a detox floor. We used the,CIWA scale, hospital wide and started Ativan at the first sign of w/d. We could and did give it every 15 minutes until the pt was stable. If that did not work we would also give Halodol.

We RARELY had to restrain a patient. If we did it was because the patient was so far into withdrawl that no matter what we did, we had to wait it out.

I have thought about initiating this where I work now, because MD's are so oblivious to how to treat it appropriately. I may do that after the first of the year. I used to educate all the incoming Resident's and nurse's on the scale and treatment. I loved that job...

We also screen EVERY patient for w/d because people minimize, or flat out lie about how much they really drink. This is a great implementation if you are working on your Clinical Advancement, if you have that at your hospital... Best of luck

The negative to the CIWA is that I have seen nurses use it to say what they want it to be.

The one thing I've found is sometimes we have to be persistent in our notification of MD's.  A lot of nurses think if they call once during the shift, their obligation is over.  Sometimes we have to be a pain in their neck, if they are not being aggressive enough.  I had a pt the other night  who was in a lot of pain.  I called 3 times in the first 4 hours, in addition to having him come up and examine the pt.  I've found if the first call doesn't  solve the problem, then you have to call and update again.  Sometimes, it's the wrong drug for that pt or just not a high enough dose.  Just making one phone call is not always enough.  UPDATE the MD.... I always say "Dr so&so, I'm calling to give you an update on YOUR pt, I wanted to let you know that we administered XYZ and this was the pt's response,"