Third year med student, just starting on the wards. Had a patient in severe alcohol withdrawl on my second rotation. Really wish I'd watched this before he came in. Please do more like this!
As a trauma staff member (usually night shift), you have to be familiar with this. Depending on which state you are in, you have to be familiar with THC intoxication and withdrawal. Make uptodate.com a bookmark or get the app.
Alcohol withdrawal is serious and can kill. Cannabis withdrawal is little more than discomfort and mood swings. So you ignorant imbeciles can kiss my ass.
This is a great idea. Commingling education, experience and humor... perfect combination! A deeper understanding is better for all concerned. Thank you.
I really like this kind of teaching, more of a discussion around the table approach. I actually took notes on this. As an ED RN, my severe alcohol withdrawal patients have always scared me because I never really understood the patho-phys and now it makes way more sense to me. I will definitely feel more confident with the next patient that comes in with this. Thank you ZDogg and fam!
It's important for family and friends to understand how serious alcohol withdrawal can be, and be ready to question the treatment someone is given in the hospital. It might come as a huge surprise to find out someone is an alcoholic since they hide it, and those around them can be in denial.
1. I love this teaching style. Thank you for doing it. 2. Regarding the CIWAs, I think that nurses, especially sometimes newer ones or ones who've never seen the DTs, will not score the CIWAs high enough. I don't know if they're afraid to score "that high", when it looks like the number is creeping toward like 12 or more. Or (gosh I hope not) they are lazy and don't want the score to be greater than 8 because then, per protocol, the patient has to be assessed Q2 instead of Q4. Also. So they aren't getting enough benzos because their CIWAs aren't high enough for the Benzos and then Code Greys get called. The protocol at my hospital is when the CIWA is greater than 15, they have to go to the unit. 3. Also. sitters..HAHAHA. It seems like I'm seeing that used less and less because they just don't want to pay for that. The AOD would rather make sure you've tried drugs and/or restraints before going that route. :( 4. I don't work in the unit, but I've had family go through this and seen management of it. I saw precedex in the unit as well as an Ativan drip. with restraints too. Thank you so much for addressing this. The only thing that could be added or a good link to information, on how to score CIWAs properly so that the patient is getting the proper treatment. You Rock. - Melinda, MS RN from Tampa.
this was awesome. we have a pt currently.in full DTs in our ICU. I fought to get psych involved and I think we will actually get the pt better now. good stuff. keep this going DrZ!!!!
Super cool that you're doing this kind of show. Switching to radiology was the best decision I ever made, but I don't want to forget all my general medicine. Will make sure to keep hitting this series up!
For anyone who experiences severe withdrawals it is serious. You can legit have a seizure while driving, and one doctor once asked me what if I hit a child when this happened to me. Wasn't driving drunk, was withdrawing.
@@user-bo5qb2rb8q not always, people drive when they’re feeling really sick all the time. And that’s what withdrawls generally feel like, you just feel horrible.
Pretty sure the reason the VA prescribed beer was because they knew their pt's weren't going to stop drinking, so why subject them to all the complications of EtOH withdrawal
I work in pharmacy in a community hospital and we still stock beer, wine, whiskey, and vodka. (Guess who gets to package the individual doses of them? It is the cheapest stuff possible and smells horrible.) Thankfully not used often anymore, but every now and then it is used. Dexmedetomidine is very popular here. Also recently switched from IV banana bags to oral thiamine, multivitamin, and folic acid in the ED when possible. Are you going to offer CE credits anytime soon? I need them for my license and most are sooo boring.
I have done a lot of hospital detoxes on patients. I love haldol, but only after putting a lot of Ativan on board. The most I have given was 36mg of Ativan in about a 4 hour period. He was crazy AF at 30mg but he finally calmed down at 36. It's amazing and scary about how much some people could handle.
Delirium tremens is a great beer. Gotta love the pink elephants and pepper flakes bottle. If you like that you'll also really like chimay (my personal fav). My hospital here in LV still has an order for "alcohol supplementation". I made a pact with my PCP, who also admits his own pts, that if I ever need to stay in the hospital he would order a beer with dinner and I could provide my own meds because I don't want that white "beer" shit. Finally, great video. Anytime we have the opportunity to learn from one another it is time well spent. One frustrating thing we deal with is if the patient is requiring longer acting benzos for alcohol withdrawal psych facilities will refuse to take the patient. So if you come to the hospital with SI and go into etoh withdrawal you get stuck staying for days on end until the long acting benzo can be DCed. Funny since inpatient psych gives benzos all day long for agitation but need it for etoh withdrawal? No we can't handle that.
I worked in an ICU for 7 yrs and loved the full on craziness, but 12 hr of repositioning 300 plus pounds patients my back has had it and I moved to a different department. Id love to rehash sepsis care and protocols.
Thank goodness for precedex in the icu! This is our icu "specialty". Valium works wonders but not when you have to give it iv. Between that and the potassium forget it. The burn it causes to give it sends the patient into a worse agitation. Ativan is ok but doesn't always work. It would be great for hospitalist and floor nurses to be more aggressive with the prevention of the severe withdrawal but when we get those patients we see the scheduled medications are often held and excused as patient calm but a ciwa is not done and their head to toe would qualify them for the minimum ciwa needed to get the scheduled doses. Not keeping these patients on the scheduled doses and assessing ciwa (or whatever protocol your facility uses to determine severity) puts every other patient and staff member in tremendous danger which unfortunately the dt patient will likely not have memory of when their dt is complete.
This is great. I work in detox (non-medically managed) and it really helped me to understand what's already happened in the hospital before the patient gets to me. The format is awesome, too. CIWA's 8? Great! Clorazepate!
Worked at a inner city hospital. Had many homeless people come in with alcohol withdrawals or they were injured or whatever. Always gave a combo of vitamins, Pepcid, Valium or Ativan and Librium/haldol. They seemed to get shipped to rehab unit because we have locked doors. So much documentation!! Many prns. Smh. Some ended up in icu, some stayed and then discharged, a few flipped out. Crazy stuff.
Alcohol comes with a lot of complications, the doctors at most hospitals in Texas don’t recognize the most under laying problems especially sedating the patient
I think this is a great video and great info! My only thing is that when a person is thinking of stopping drinking and watches this all they heard was ..SEIZURES, DEATH, Billy DEE WILLIAMS DIED? I wish to help it be clarified as much as possible to take the fear out of people wanting to stop alcohol but the fear is stopping them. I see and hear this as a majority of the excuses on NOT stopping drinking in problem drinkers. Is there better statistics for the laymen to understand because from what i read its very rare to go through DT"S and not the confussion of all of the symptoms are DT's....do you Kinda understand? lol/! My internet warrior self found from certain studies that in General 5% will get the DT's or fall into the category and of that 5%...10% do die but in order to even fall into that final 5% a person has to drink sooo sooo much for years and years. Study i saw said 10 plus years constant drinking unbelievable insane amounts everyday were in that 5%. Feel free to tear these numbers up but all i am trying to do is find out a General rule of thumb statistics. Any ideas or approaches cause all i see is fear fear of DEATH!!!!! and SEIZURE!!!!! Which most dont have. Erase this comment if you feel it does no good or passes along bad info...either way I like ur vids and message
@@rowanfrancis9011 Good job. Remember that after the first 30 days u have NO alcohol in ur system what so ever. So the physical dependancy should be taken care of. To me the physical dependancy is 10% of the battle. The other 90% is mental and thats really where it is won or lost. Don't know how long u plan on not drinking but the stuff really is poison. Hope you put it down for years to come
The occasional input from Tom (the "I hate you Tom Hieny-whatever at the end) keeps people listening until the end, which maximizes your youtube revenue. Not sure if Facebook works the same way, but that's a fun and speedy way to keep us until the last second.
The VA doesn't give beer anymore. They no longer have detox units. They avoid admitting detox patients if possible unless there is justifiable criteria to admit. Most detox patients are being detoxed through ambulatory outpatient detox through the mental health department. They are assessed by a nurse, Medicine is prescribed by a doctor according to the protocol. They go home with meds and return to see the the nurse daily x 5 days. If they seem to be deteriorating we send them to the er to be admitted. To participate in ambulatory outpatient detox they need a caregiver to stay with them, someone to drive them to the clinic daily, and a sober environment at home. This is not easy to obtain. It is not a perfect program but I was amazed at the amount of heavy drinkers that did very well. Most of them do not require hospitalization surprisingly! We monitor VS , CIWA SCORE, lab work etc. meds are adjusted according to symptoms. Signed- Va detox nurse
ETOH withdrawal was one of my least favorite patient types to take care of when I worked in the ICU. As you bring up, they can get pretty critical if not managed properly if many comorbidities are present. As they are crashing and burning with you busting your ass to save them they're likely to hit you or spray varices blood in your face.
CannaToker420 They don't wanna use a very addicting substance to help someone get over their addiction to a very addicting substance!!! They worry their addiction will just change faces.
Thank you Dr. D, I love your vids and I appreciate them. They are evidenced based. I've been an RN for 30 some years (in every specialty) and We nurses are all subscribed to you on FB. I work in a psych facility and we use CIWAs and ativan.
@@sasha-sv2xv you might needs meds to help you along. They put me on clonodine for about 2 months but also I went to a rehab to start my recovery. It will get better my friend I promise. I’m always here if you need to talk.
27:14 considering its properties would cbd (just cbd no thc ) if you dony have access to benzos do any good , or at least buy some time to get some more serious help. As there is a lot of drinkimg in rural areas . And some peopel are a bit to stubborn to taper
Have you heard of treating Etoh w/d with high doses of Gabapentin and Clonodine patches instead of Benzos? I work with detox patients and I have seen some success with this new treatment. Also I want to point out high ammonia levels can cause some delirium but not exactly DT's.
Feeling that sense of power and confidence is amazing. It's actually basic: a technique, like the one in Steffon Barkload's approach (googl him) will give you no option than to want to quit definitely within an hour or so.
Third year med student, just starting on the wards. Had a patient in severe alcohol withdrawl on my second rotation. Really wish I'd watched this before he came in. Please do more like this!
As a trauma staff member (usually night shift), you have to be familiar with this. Depending on which state you are in, you have to be familiar with THC intoxication and withdrawal. Make uptodate.com a bookmark or get the app.
@@thevine2010 Cannabis withdrawal?
Are you a devout Christian?
@@julienwatkins3574 Cannabis hyperemesis. You a dumbass?
@@julienwatkins3574 there is a cannabis withdrawal. Sorry you aren’t informed.
Alcohol withdrawal is serious and can kill.
Cannabis withdrawal is little more than discomfort and mood swings.
So you ignorant imbeciles can kiss my ass.
Yes, I do like this form of education; it's like the nurses station at 0330.
Gia Daniel totes true!
This is a great idea. Commingling education, experience and humor... perfect combination! A deeper understanding is better for all concerned. Thank you.
I really like this kind of teaching, more of a discussion around the table approach. I actually took notes on this. As an ED RN, my severe alcohol withdrawal patients have always scared me because I never really understood the patho-phys and now it makes way more sense to me. I will definitely feel more confident with the next patient that comes in with this. Thank you ZDogg and fam!
It's important for family and friends to understand how serious alcohol withdrawal can be, and be ready to question the treatment someone is given in the hospital. It might come as a huge surprise to find out someone is an alcoholic since they hide it, and those around them can be in denial.
1. I love this teaching style. Thank you for doing it.
2. Regarding the CIWAs, I think that nurses, especially sometimes newer ones or ones who've never seen the DTs, will not score the CIWAs high enough. I don't know if they're afraid to score "that high", when it looks like the number is creeping toward like 12 or more. Or (gosh I hope not) they are lazy and don't want the score to be greater than 8 because then, per protocol, the patient has to be assessed Q2 instead of Q4. Also. So they aren't getting enough benzos because their CIWAs aren't high enough for the Benzos and then Code Greys get called. The protocol at my hospital is when the CIWA is greater than 15, they have to go to the unit.
3. Also. sitters..HAHAHA. It seems like I'm seeing that used less and less because they just don't want to pay for that. The AOD would rather make sure you've tried drugs and/or restraints before going that route. :(
4. I don't work in the unit, but I've had family go through this and seen management of it. I saw precedex in the unit as well as an Ativan drip. with restraints too.
Thank you so much for addressing this. The only thing that could be added or a good link to information, on how to score CIWAs properly so that the patient is getting the proper treatment.
You Rock. - Melinda, MS RN from Tampa.
this was awesome. we have a pt currently.in full DTs in our ICU. I fought to get psych involved and I think we will actually get the pt better now. good stuff. keep this going DrZ!!!!
Super cool that you're doing this kind of show. Switching to radiology was the best decision I ever made, but I don't want to forget all my general medicine. Will make sure to keep hitting this series up!
But watching you guys bro out and bullshit together is hilarious too.
For anyone who experiences severe withdrawals it is serious.
You can legit have a seizure while driving, and one doctor once asked me what if I hit a child when this happened to me. Wasn't driving drunk, was withdrawing.
Well if your withdrawing that bad you can't walk never mind drive a car or even get into the car
@@user-bo5qb2rb8q not always, people drive when they’re feeling really sick all the time. And that’s what withdrawls generally feel like, you just feel horrible.
Pretty sure the reason the VA prescribed beer was because they knew their pt's weren't going to stop drinking, so why subject them to all the complications of EtOH withdrawal
I work in pharmacy in a community hospital and we still stock beer, wine, whiskey, and vodka. (Guess who gets to package the individual doses of them? It is the cheapest stuff possible and smells horrible.) Thankfully not used often anymore, but every now and then it is used.
Dexmedetomidine is very popular here. Also recently switched from IV banana bags to oral thiamine, multivitamin, and folic acid in the ED when possible.
Are you going to offer CE credits anytime soon? I need them for my license and most are sooo boring.
Mandy Wultsch when l worked as a pct in an ICU l remember a pt was actually drinking Budweiser beer can .
As a med student, I love this! It's a great relaxed break from study and I'm learning!
Down to 4 drinks a day (6%) shooting for 2 .then hopefully I will be able to stop without meds.
Good luck man. Hope it worked for you!
I have done a lot of hospital detoxes on patients. I love haldol, but only after putting a lot of Ativan on board. The most I have given was 36mg of Ativan in about a 4 hour period. He was crazy AF at 30mg but he finally calmed down at 36. It's amazing and scary about how much some people could handle.
Delirium tremens is a great beer. Gotta love the pink elephants and pepper flakes bottle. If you like that you'll also really like chimay (my personal fav). My hospital here in LV still has an order for "alcohol supplementation". I made a pact with my PCP, who also admits his own pts, that if I ever need to stay in the hospital he would order a beer with dinner and I could provide my own meds because I don't want that white "beer" shit. Finally, great video. Anytime we have the opportunity to learn from one another it is time well spent. One frustrating thing we deal with is if the patient is requiring longer acting benzos for alcohol withdrawal psych facilities will refuse to take the patient. So if you come to the hospital with SI and go into etoh withdrawal you get stuck staying for days on end until the long acting benzo can be DCed. Funny since inpatient psych gives benzos all day long for agitation but need it for etoh withdrawal? No we can't handle that.
Teach this in the jails because they dont even give a shit when people die in there.
So that’s why my grandmother was given halidol by hospic. She was seeing people who were not there.
I worked in an ICU for 7 yrs and loved the full on craziness, but 12 hr of repositioning 300 plus pounds patients my back has had it and I moved to a different department. Id love to rehash sepsis care and protocols.
Thank goodness for precedex in the icu! This is our icu "specialty". Valium works wonders but not when you have to give it iv. Between that and the potassium forget it. The burn it causes to give it sends the patient into a worse agitation. Ativan is ok but doesn't always work.
It would be great for hospitalist and floor nurses to be more aggressive with the prevention of the severe withdrawal but when we get those patients we see the scheduled medications are often held and excused as patient calm but a ciwa is not done and their head to toe would qualify them for the minimum ciwa needed to get the scheduled doses.
Not keeping these patients on the scheduled doses and assessing ciwa (or whatever protocol your facility uses to determine severity) puts every other patient and staff member in tremendous danger which unfortunately the dt patient will likely not have memory of when their dt is complete.
What are some of the milder drugs, for mild withdrawal.
Also, instant subscribe. Great video.
This is great. I work in detox (non-medically managed) and it really helped me to understand what's already happened in the hospital before the patient gets to me. The format is awesome, too.
CIWA's 8? Great! Clorazepate!
Henry Lawson the Australian fiction author back in day , wrote a vivid short story about a drover who died nasty from the DT's
Worked at a inner city hospital. Had many homeless people come in with alcohol withdrawals or they were injured or whatever. Always gave a combo of vitamins, Pepcid, Valium or Ativan and Librium/haldol. They seemed to get shipped to rehab unit because we have locked doors. So much documentation!! Many prns. Smh. Some ended up in icu, some stayed and then discharged, a few flipped out. Crazy stuff.
Love this channel. Would love more learning videos..PE, SIADH, etc. You guys are great!!
Here in 2024 2 years sober everything you guys is speaking
Proud patreon supporter here -- more teaching! this was really helpful.
Thank you for your support! patreon.com/zdoggmd
Cathy Lindsay
Resources for the articles discussed please?
Alcohol comes with a lot of complications, the doctors at most hospitals in Texas don’t recognize the most under laying problems especially sedating the patient
This is the most serious, unserious podcast I ever came across lol
I think this is a great video and great info! My only thing is that when a person is thinking of stopping drinking and watches this all they heard was ..SEIZURES, DEATH, Billy DEE WILLIAMS DIED? I wish to help it be clarified as much as possible to take the fear out of people wanting to stop alcohol but the fear is stopping them. I see and hear this as a majority of the excuses on NOT stopping drinking in problem drinkers. Is there better statistics for the laymen to understand because from what i read its very rare to go through DT"S and not the confussion of all of the symptoms are DT's....do you Kinda understand? lol/! My internet warrior self found from certain studies that in General 5% will get the DT's or fall into the category and of that 5%...10% do die but in order to even fall into that final 5% a person has to drink sooo sooo much for years and years. Study i saw said 10 plus years constant drinking unbelievable insane amounts everyday were in that 5%. Feel free to tear these numbers up but all i am trying to do is find out a General rule of thumb statistics. Any ideas or approaches cause all i see is fear fear of DEATH!!!!! and SEIZURE!!!!! Which most dont have. Erase this comment if you feel it does no good or passes along bad info...either way I like ur vids and message
n2cable would love to see if they respond because i noticed the stats too
Done with drawal no big problems , Not that heavy
@@rowanfrancis9011 Good job. Remember that after the first 30 days u have NO alcohol in ur system what so ever. So the physical dependancy should be taken care of. To me the physical dependancy is 10% of the battle. The other 90% is mental and thats really where it is won or lost. Don't know how long u plan on not drinking but the stuff really is poison. Hope you put it down for years to come
@@n2cable thanks I hope so too🙏
@@n2cable 8 weeks sober
I’ve recently quit and withdrawals are minimal so feeling lucky
The occasional input from Tom (the "I hate you Tom Hieny-whatever at the end) keeps people listening until the end, which maximizes your youtube revenue. Not sure if Facebook works the same way, but that's a fun and speedy way to keep us until the last second.
I am a sitter, it is HORRIBLE to see this😕😔 Dangerous gor staff!
The VA doesn't give beer anymore. They no longer have detox units. They avoid admitting detox patients if possible unless there is justifiable criteria to admit. Most detox patients are being detoxed through ambulatory outpatient detox through the mental health department. They are assessed by a nurse, Medicine is prescribed by a doctor according to the protocol. They go home with meds and return to see the the nurse daily x 5 days. If they seem to be deteriorating we send them to the er to be admitted. To participate in ambulatory outpatient detox they need a caregiver to stay with them, someone to drive them to the clinic daily, and a sober environment at home. This is not easy to obtain. It is not a perfect program but I was amazed at the amount of heavy drinkers that did very well. Most of them do not require hospitalization surprisingly! We monitor VS , CIWA SCORE, lab work etc. meds are adjusted according to symptoms.
Signed- Va detox nurse
Position the red alarm light in the middle of the wooden cube. It's bothering me
I enjoy this form of education. Keep it up. - Brett Whaley, MSN, RN, ACNP-BC
ETOH withdrawal was one of my least favorite patient types to take care of when I worked in the ICU. As you bring up, they can get pretty critical if not managed properly if many comorbidities are present. As they are crashing and burning with you busting your ass to save them they're likely to hit you or spray varices blood in your face.
Dr. Z gonna start detoxing at home tomorrow morning. Have some Librium and Ativan and I know it's gonna be horrible but it's gotta be done
Fantastic I’ve had some very dangerous home alone detox
Just curious, why is Alprazolam never used when treating alcohol withdrawal?
CannaToker420 They don't wanna use a very addicting substance to help someone get over their addiction to a very addicting substance!!! They worry their addiction will just change faces.
It is in my facility.
Wrong, AIDES are with patients longer now a days
Thank you! All I've heard for alcohol withdrawal is dilantin with benzos if they get upset. This method seems so much better!
La croix is an American made product in my home state Michgan!! And that's my favorite flavor! :-)
Thank you Dr. D, I love your vids and I appreciate them. They are evidenced based. I've been an RN for 30 some years (in every specialty) and We nurses are all subscribed to you on FB. I work in a psych facility and we use CIWAs and ativan.
So using just adivan is also basically a super soaker
Just take the librium
yes to ordering beer to bedside
Ooh maaaan my alcohol withdrawal was straight messed up. Paaaaaaainfuuuuul
How long it lasted...in 28 days now and still sick
@@sasha-sv2xv you might needs meds to help you along. They put me on clonodine for about 2 months but also I went to a rehab to start my recovery. It will get better my friend I promise. I’m always here if you need to talk.
@@thegingerunicorn178 as we speak I'm back at the dr
Do you have I.g?
@@thegingerunicorn178 I'm also on diazepam..thiamine. omega 3 ..bevidoxine..and I was on tegretol
That's because benzos are allosteric GABA agonists right?
According to wikipedia
Damn it you never explained halidol thanks to that interruption
Thank you Sarah
24:51 do people with autism have a higher risk for delerium tremins
What about gabapentin
ETOH 1.5
STANFORD RESIDENCY 9
I WONDER WHICH IS WORSE FOR MY HEALTH, AND WHAT WOULD THE DSM SAY ABOUT RESIDENCY?
What’s your relative score?
Always a education, THANKS❣
12:56 actualy horror film mosters is more likely do to being as anxious as you could possibly bee.
As a complete muggle this was interesting to me, I hope you do more.
Doing On report on how VC cures sepsis. Hope you don't mind.
You can't do the ad or valu
27:14 considering its properties would cbd (just cbd no thc ) if you dony have access to benzos do any good , or at least buy some time to get some more serious help. As there is a lot of drinkimg in rural areas . And some peopel are a bit to stubborn to taper
How do I find you clowns
Have you heard of treating Etoh w/d with high doses of Gabapentin and Clonodine patches instead of Benzos? I work with detox patients and I have seen some success with this new treatment. Also I want to point out high ammonia levels can cause some delirium but not exactly DT's.
I drink when I wake up😥
43:42 also it reduces dopamine which is not nice to do to somome im withdrawal .
I’ve seen Nic Cage in a strip club I once worked at in Vegas
7:21 does that number include the nurses 😂😂😂😂😂😂😂😂😂😂😂😂😂😂😂 ive heard 1 in 5 healthcare workers have a substance abuse problem
I had to be given benzodiazepines to help through the withdrawal safely. Otherwise I definitely would not have survived it.
DEEP IN THE HEAAART OF TEXAAAAAS
You don't give an alcoholic valium what is wrong with you
Loved it!
Fou d this very interest g hubby died cause they left him 15 hours without detox
You should just learn
Feeling that sense of power and confidence is amazing. It's actually basic: a technique, like the one in Steffon Barkload's approach (googl him) will give you no option than to want to quit definitely within an hour or so.
awkward..
So laughing how fucken funny is this I'm in the struggle
What is halidol DAMN IT TOM STOP INTERUPTING
0:20 drunk already???
Can't stand this production.
Disliked @the a-a-a-a-alcohol
🤣🤣🤣🤣🤣🤣
Dur
I will be the happiest person
You guys are cool. But it's not funny
First