![]() ![]() ![]() Rapid response diagnostics: consider finger stick, head CT/MRI, infectious workup, telemetry, medication list review, Ativan (lorazepam) and Keppra (levetiracetam) IV load, or ABG.Rapid response differential: stroke (ischemic or hemorrhagic), sepsis, hypoglycemia, cardiac arrhythmia (check pulse), seizure, medication side effect, hypercarbia, delirium.If relatively high use of Ativan PRN but then CIWA 0-8 for over 24 hours, can calculate total use of Ativan in 24 hours and give over 4 divided q6hr doses and taper by 20% per day afterward.If relatively low use of Ativan PRN can just stop and monitor.Consider transfer to ICU if unable to protect airway, CIWA > 15 for more than an hour, given Ativan > 6mg in 1hr or > 12mg in 6hrs, hemodynamic instability.If CIWA 16+ give Ativan 1, 2, or 4mg IV every 15 minutes until CIWA 15 (monitoring vital signs and mental status within 15 minutes of dose).If CIWA 9-15 give Ativan 1mg, 2mg, or 4mg IV (sequential escalation) every 2-4 hours (monitoring vital signs and mental status within 15 minutes).If CIWA 0-8 can check CIWA score every 6 hours at the start, hold off on Ativan.Use of Serax (oxazepam) and Librium (chlordiazepoxide) prophylaxis varies between providers and institutions.Nurses will check CIWA score (Clinical Institute Withdrawal Assessment) with maximum score 67 made of 10 components: nausea/vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory hallucinations, visual hallucinations, headache, disorientation/clouded sensorium.Question to ask: if history of seizures/delirium tremens (DTs) then consider prophylactic Ativan (lorazepam) with 1-2mg PO Ativan every 6 hours on day 1 x 4 doses, 1mg PO every 6 hours on day 2-3 x 8 doses.Patients with heavy alcohol use should also get thiamine (IV or IM at the beginning if giving dextrose containing fluids but do not give any dextrose until thiamine has been given via banana bag or separately), folate, and a multivitamin.Symptoms worse 24-72 hours after last use.Please consult with your team for individual diagnostic and treatment decisions. Study Guide by Specialty (formerly )ĭisclaimer: the clinical information on this site is only meant to serve as a reference.
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