WILTIMS #323: To the Wayback Machine!

Today was fun. I got to leave my clerkship early to give a presentation to the incoming first year class during their orientation. Looking all the way back to when I was in their seats is a bit easier for me than most thanks to this blog. Here is the post from my Tuesday of orientation week. I think it's especially fitting that the group I was presenting on behalf of today did not exist when I was an incoming first year. Our school is always evolving and attempting to make things better. I wonder what changes this new class inspires in the years to come...

TIL: One of the several protocols for tapering a patient down from severe alcohol withdrawal is seen below. Since alcohol's sedative effects act primarily through GABA receptors, instead of giving them more alcohol in the hospital (which would be bad due to all of alcohol's other effects) we supplement with another GABA agonist, usually in the benzodiazepine class of drugs. Below is what the actual order would look like in a patient's chart. The ordering physician would also check on the patient periodically to see if the withdrawal symptoms are being appropriately managed. If not, then the orders might be altered to add another day to give the patient's body time to begin detoxifying itself.

50mg chlordiazepoxide PO Q6h on day 1
50mg chlordiazepoxide PO Q8h on day 2
50mg chlordiazepoxide PO BID on day 3
25mg chlordiazepoxide PO BID on day 4
25mg chlordiazepoxide PO QAM on day 5
25mg chlordiazepoxide PO Q4h prn breakthrough anxiety, max 3 doses/day
Vitals Q4h
If SBP < 100 or DBP < 60 or HR > 100 or pt displays marked sedation HOLD MEDS

Legend: mg = milligrams, PO = by mouth, QXh = every X hours, BID = twice daily, QAM = every morning, prn = as needed, SBP = systolic blood pressure, DBP, = diastolic blood pressure, HR = heart rate, pt = patient