Yes, I do like this form of education; it's like the nurses station at 0330.

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!

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!!!!

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!

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.

Teach this in the jails because they dont even give a shit when people die in there.

As a med student, I love this! It's a great relaxed break from study and I'm learning!

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!

What are some of the milder drugs, for mild withdrawal. Also, instant subscribe. Great video.

Love this channel. Would love more learning videos..PE, SIADH, etc. You guys are great!!

Resources for the articles discussed please?

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

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.

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.

As a complete muggle this was interesting to me, I hope you do more.

Position the red alarm light in the middle of the wooden cube. It's bothering me

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.

Always a education, THANKS❣

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!

Proud patreon supporter here -- more teaching! this was really helpful.

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.

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.

So that’s why my grandmother was given halidol by hospic. She was seeing people who were not there.

I enjoy this form of education. Keep it up. - Brett Whaley, MSN, RN, ACNP-BC

Here in 2024 2 years sober everything you guys is speaking

Loved it!

Thank you Sarah

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.

Just curious, why is Alprazolam never used when treating alcohol withdrawal?

yes to ordering beer to bedside

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.

Just take the librium

Doing On report on how VC cures sepsis. Hope you don't mind.

You can't do the ad or valu

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.

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.

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?

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’ve recently quit and withdrawals are minimal so feeling lucky

So using just adivan is also basically a super soaker

Fantastic I’ve had some very dangerous home alone detox

Thank you! All I've heard for alcohol withdrawal is dilantin with benzos if they get upset. This method seems so much better!

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

Henry Lawson the Australian fiction author back in day , wrote a vivid short story about a drover who died nasty from the DT's

So laughing how fucken funny is this I'm in the struggle

How do I find you clowns

Damn it you never explained halidol thanks to that interruption

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

That's because benzos are allosteric GABA agonists right?

I am a sitter, it is HORRIBLE to see this😕😔 Dangerous gor staff!

Wrong, AIDES are with patients longer now a days

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

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

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.

Down to 4 drinks a day (6%) shooting for 2 .then hopefully I will be able to stop without meds.

DEEP IN THE HEAAART OF TEXAAAAAS

I drink when I wake up😥

Ooh maaaan my alcohol withdrawal was straight messed up. Paaaaaaainfuuuuul

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.

I had to be given benzodiazepines to help through the withdrawal safely. Otherwise I definitely would not have survived it.

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.

Fou d this very interest g hubby died cause they left him 15 hours without detox

You should just learn

I’ve seen Nic Cage in a strip club I once worked at in Vegas

awkward..

I will be the happiest person

0:20 drunk already???

Dur

You don't give an alcoholic valium what is wrong with you

🤣🤣🤣🤣🤣🤣

What is halidol DAMN IT TOM STOP INTERUPTING

Disliked @the a-a-a-a-alcohol

Can't stand this production.

You guys are cool. But it's not funny

First