Focus on the Surgical and Elderly Patients集中在外科老年患者.pptVIP

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Focus on the Surgical and Elderly Patients集中在外科老年患者.ppt

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Focus on the Surgical and Elderly Patients集中在外科老年患者

AWS in Surgical Patients:Treatment Supportive care Pain management Pulmonary toileting Eliminate catheters Early mobility Pharmacological treatment BZD Symptom-triggered Dosages generally larger Copyright Alcohol Medical Scholars Program * This Lecture Reviews Neurobiology of AWS √ Signs and symptoms of AWS √ Evaluation of patients √ Treatment overall √ Special considerations Surgical patients √ Elderly Copyright Alcohol Medical Scholars Program * AWS in the Elderly Epidemiology 11% of elderly medical inpatients have AUD 20% in psychiatric settings 14% in emergency departments Risks Age: ↑ disease burden;↑ risk of withdrawal Age ? alcohol concentration Interactions with medications Copyright Alcohol Medical Scholars Program * AWS in Elderly Patients: Challenges Age ? predictor of ↑ withdrawal severity Early onset drinkers?↑ severity of AWS Functional reserve and tolerance of physiological stressors ↓ ↑ risk of adverse effects from use of BZDs Cognitive impairment Daytime sedation Falls Copyright Alcohol Medical Scholars Program * AWS in Elderly Patients: Assessment I History: Patient ashamed to admit Family reluctant to share Physicians not likely to suspect Clues ↑ suspicion of AUD: Frequent falls/ bruises ED visits ↑ blood pressure Depressed mood and suicidal thoughts Insomnia Copyright Alcohol Medical Scholars Program * AWS in Elderly Patients: Assessment II Differential diagnosis: Other substances Delirium of other causes Psychiatric conditions Copyright Alcohol Medical Scholars Program * AWS in Elderly Patients:Treatment I Supportive treatment: Safe/well lit environment Gentle/empathic/non-judgmental approach Hearing aids/glasses Avoid extremes of sensory input Sleep/rest/nutrition Copyright Alcohol Medical Scholars Program * AWS in Elderly Patients:Treatment II Shorter acting BZDs preferred No active metabolites ↓ rate of side effects Symptom-triggered History of sz and DTs ?fixed schedule. Hold for sedation Medication dosages typica