Here’s my current alcohol withdrawal treatment algorithm. An | Figure 1

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Here’s my current alcohol withdrawal treatment algorithm. Anyone see any issues with the pathway?

Why you should join Figure 1

A 35 yr old male presents to the ED by EMS for alcohol intoxication and possible seizure.

VS stable. GCS of 14. + ETOH. Phenytoin level 9. Albumin 3.5. Hx: alcohol abuse, noncompliant with medications.
When discussing how to best care for this pt my preceptor advices 100mg of dilantin IV and then increase his meds.
QUESTIONS:

  1. Is there a method of correcting phenytoin levels based off the pt‘s current level? The closest resource I could find was the “top up method“ from the pdf below.
  2. As ED providers should we be altering a pt‘s seizure medications?

A 22 yr old male with c/o RUQ pain for 48 hours accompanied by nausea and anorexia the past couple of days. The pain started 8 hours after a drinking binge 2 days ago (approx 1/2 liter of vodka shots). Pain has been worsening over past 48 hours from a 2/10-5/10. Vomited x2 initial morning after binge, no vomiting since. He had a similar episode some months ago after drinking too much but was less severe and went away fairly quickly. Patient had to leave in a hurry for midterms but returned in 2 days. See below: WBC 13.3; HGB 15.1; Plts 125,000; Amylase 250u/L; Lipase 200u/L; AST 180u/L, SST/ALT ratio 3.1; T-Bili 2.1; D-Bili 0.3mg/dl; Hep panel A, B, C all negative; GGT elevated; ABD films with non-descriptive air patterns; no ileus or obstructive patterns.

Imagine a dependency that doesn’t smell like alcohol. Doesn’t slur speech. Doesn’t destroy careers or shatter families. At least — not in the way you expect.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.

He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.