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The doc can order ativan evry two hours. It won't kill the patient.

How long should it take for the Ativan to kick in?  I felt so bad for this lady because she didn't know where she was or who I was.  Just an hour before she was thanking me for helping her.  It was as if she was experiencing something bad that had happened to her before and the RN and I were people other than who we were.  We just kept the EKG wires off her and tried to get her O2 sats whenever she would let us.  I just stood there with my hands in my pockets and listened. It was my first experience seeing someone going through withdrawal and I never realized how bad it can be for them.  Thanks for the input.  I am so thankful for all of you.  It really helps me see things from different points of view.

Thanks CD,  I'll so some research

snowbunnyRN says ...

In regards to an Alcohol Withdrawal Protocol that had been suggested by CD Nurse, the facility that I work in is formulating one at the present time to be in effect in the near future.  At this time , we are relying on individual MD's orders .  However, I am seeing many of our MD's ordering Ativan Q 1 Hr instead of Q 2 hr in IV route - not PO. It seems to work fairly well.  The key to it's success is early recognition of an alcohol problem  on admission of the pt. to get the Ativan 'on board' .  With early intervention, initiating the Ativan at 1st signs of withdrawal --  this seems to be the key to having some control over the combative and other behaviors that a person would exhibit.  Hope this helps.

Thanks for the info.  This situation has really made me want to learn more about this disease.  We are getting more and more patients coming through with alcohol withdrawal.  We aren't equipped up in mental health to take care of them so they go down to ICU.  I think there is a protocol in place and this particular patient had already been through several days of taking Ativan.  There aren't many local substance abuse facilities in our area.  The closest one is always full.  They only accept insurance or people who can pay their $15,000.00 fee.  Most of the people coming through our facility don't have insurance or are court-ordered to be there.  It's a good thing we are a not-for-profit hospital or most of these people wouldn't be getting the care they need.

kendbeef says ...

Does anyone out there have any good advice on how you provide cares for a patient going through ETOH withdrawal and combatitive.  This patient was hallucinating, pulling off EKG lines, O2, trying to pull out IV line and cath.  Pt was hitting us and I was called every name under the sun and threatened.  I know the pt won't remember it....earlier pt was very nice and then BOOM she was out there!  Dr. restarted the Ativan but after an hour and a half it wasn't making a dent in the behavior.  I didn't take any of it personally, I just wish I understood it better so that I could provide care in a positive way and keep myself safe. 

I work on a unit where we frequently get pts in etoh withdrawal, When they are that far gone, and not responding to the ativan, they need ICU. They can be intubated and knocked right out for a few days, which in many cases is what they need. At the hospital I work at we have an Ativan Protocol, this is a tool we use to score a pt, and medicate according the how high they score. At first they are being scored every half hour, and medicated with anywhere from .5mg to 4 mg of ativan IV, and also recieving up to 2 to 4 mg every 4 hours atc. I used to work in ICU. I once had a pt who was getting 20mgs of ativan every hour, with a prn of 10 mgs every half hour. He was stilll awake and talking to me.

 Never be afraid to get an icu consult.