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Strayerisms – Preventing Alcohol Withdrawal

Reuben Strayer, MD
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11:57
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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03:15

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EM:RAP 2017 January Written Summary 926 KB - PDF

Reuben gives his strategy of managing acute alcohol withdrawal. Don't treat, he says, prevent.

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brendanC -

In a select few I will provide an oral loading dose of phenobarbital along with 2 take home valium 5 mg at discharge. No Rx. This makes for a sedated, less likely to drink patient, who can have valium if urge/symptoms develop. Little risk of OD and better chance of compliance with not drinking. Only do this if conversation suggests earnest desire to stop and no inpatient beds available. (which Is the usual).

Brendan C

Reuben Strayer (@emupdates) -

thanks for your comment Brendan. this type of front-loaded detox makes a lot of sense in carefully selected patients. the concern many providers have in this population–I think justified–is that your patient then decides to add to his phenobarb load with a fifth of vodka, then top it off with a couple of the valium tabs. I agree no inpatient beds available is usual; in my experience earnest desire to stop is much less usual. So, yes, with emphasis on what you call _a select few_.

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