(精选)The Medical Management of ALCOHOL WITHDRAWAL教学课件.pptVIP

1 Play file: 0 - Tequila 2 The Medical Management of ALCOHOL WITHDRAWAL John J. Stasinos, M.D. LTC(P), MC, USA Chief, Chemical Addictions Treatment Services Department of Psychiatry Tripler Army Medical Center 3 Disclosures I have no affiliation or financial relationship with any pharmaceutical companies The opinions stated herein are my own Off-label use of medications will be discussed I am not on any medications or mood-altering substances... 4 Outline Epidemiology Definitions Pathophysiology Diagnosis Manifestations Management 5 Objectives By the end of this briefing, you will be able to… Identify, assess, diagnose patients in acute EtOH withdrawal Determine the best setting for conducting management of withdrawal symptoms Manage patients with medically complicated EtOH withdrawal Grasp systemic administrative issues that complicate care put patients at unnecessary risk 6 Why Are We EvenTalking About This?... Joint Commission standards policies have impacted our perceptions decisions regarding medical management of EtOH withdrawal Disagreement persists among health care providers regarding how where these patients are best cared for 7 What Standards?... Joint Commission recently published new standards that specifically apply to procedure of “detoxification” Standards require personnel, training, equipment that represent considerable $ Some institutions sidestep the issue by declaring: “WE DON’T DO DETOX” 8 What Disagreement?... 12 Clinical Vignette 22 y/o SWM AD/MC E4 c hx of EtOH Dependence Brought to TAMC ER by Command escort after found to be intoxicated with EtOH ER assessment: BAL UDS negative House staff: “We don’t do detox [at TAMC].” Pt has a grand mal seizure ICU course: seizures, delirium tremens, pneumonia, intubation ventilation, management with iv benzos Discharged from hospital after 37 days 13 14 Terminology Withdrawal Characteristic group of signs symptoms that typically develop after rapid, marked decrease or discontinuation