alcohol withdrawal Flashcards
65 y.o. man arrives in A&E smelling strongly of alcohol, having been found unconscious after an alleged assault
he’s well known to the department, last presented 1 week ago with alcohol withdrawal
you check his ABC, stabilise his cervical spine and begin clinical examination
(a) routine obs normal, examination: two finger-breadths of hepatomegaly but no stigmata of CLD. routine blood tests show no differences from results from last week. you decide he should be admitted overnight. no next of kin.
in a Scottish hospital, who can give consent for further medical rx and under what auspices?
adults with incapacity (Scotland) act 2000 - part 5
appointed welfare attorney or guardian
if not, Dr is authorised to treat as appropriate
section 47 certificates must be filled in
(b) you decide to manage him as alcohol withdrawal syndrome.
list 2 forms of treatment you would institute.
- nutritional - Pabrinex (vit B and C)
- Librium (chlordiazepoxide) - for withdrawal sx
- CIWA (Clinical Institute Withdrawal Assessment for Alcohol) scale for administering benzos
you are called to the ward an hour later. pt is increasingly agitated and unresponsive. newly enlarged pupil on the left side with corresponding UMN signs in L arm and leg. blood glucose normal.
(c) give 2 most likely causes of this acute deterioration.
- Intracranial haemorrhage leading to transtentorial herniation with false localising sign of left pupil dilatation.
- Stroke.
(d) list 4 other causes of reduced GCS in such a pt
- Wernicke-Korsakoff syndrome
- Acute alcohol withdrawal with delirium tremens
- Dehydration
- Hypothermia
- Infection
(e) what is your next investigation?
CT head
(f) whilst you are arranging investigations, nurse tells you that pt is having recurrent tonic-clonic seizures. you dx status epilepticus.
name 2 drugs you could use to terminate this episode.
PR diazepam
IV lorazepam
