3354cch alcoholwithdrawalicu

ADULT ICU ALCOHOL WITHDRAWAL PROTOCOL ORDERS
ICU ADMISSION REQUIRED – CAUTION WITH ACTIVE RESPIRATORY CONDITIONS
REQUIRES APPROVAL BY PULMONARY / CRITICAL CARE PHYSICIANS
This document is only a reference guide and is not intended to delineate a required standard of care
or act as a substitute for a physician's medical judgment for individualized patient care.
1. VITAL SIGN MONITORING
CIWA-A (Clinical Institute Withdrawal Assessment for Alcohol) every 4 hours until CIWA-A less than 10 x 3 evaluations plus Vital Signs per ICU routine.
2. NOTIFY PHYSICIAN
❑ Notify the physician for concerns regarding over-sedation with benzodiazepines, as exhibited by SaO2 less than 92% on room air and/or Respiratory Rate less than 10 and if patient progresses to next CIWA-A level.
MEDICATIONS
1. IV FLUIDS
2. GI MEDICATIONS
Aluminum and Magnesium Hydroxide (Maalox) 30 ml PO every 6 hours PRN epigastric distress 3. NICOTINE REPLACEMENT
❑ Nicotine (Nicoderm) Transdermal patch 21 mg Daily 4. ADDITIONAL MEDICATIONS
A. VITAMIN ADMINISTRATION
❑ PO PATIENTS
Thiamine (Vitamin B1) 100 mg PO daily x 3 Days Multivitamin with Folic Acid, One tablet PO Daily ❑ NPO PATIENTS
Add standard injectable multi-vitamins, Thiamine (Vitamin B1) 100 mg and Folic Acid 1 mg per liter to prescribed IV Fluids once daily X 3 Days B. ❑ Haloperidol (Haldol) 5 mg PO / IV every 4 hours PRN delirium, hallucination, agitation C. ADDITIONAL THERAPY – Can be combined with Treatment for Alcohol Detoxification protocol; to be
used for patients with opioid withdrawal – (Please Indicate):
❑ Clonidine (Catapres) 0.1 mg PO every 4 hours PRN symptoms of nausea, abdominal cramps or diarrhea OR ❑ Clonidine (Catapres TTS1) (0.1 mg) every week
❑ Clonidine (Catapres TTS2) (0.2 mg) every week ❑ Clonidine (Catapres TTS3) (0.3 mg) every week continued on page 2
PHYSICIANS ORDERS
LEE MEMORIAL HEALTH SYSTEM
Lee County, Florida
ADULT ICU ALCOHOL WITHDRAWAL
PROTOCOL ORDERS
FM# 3354 Pub. 08/13 Page 1 of 3
UCO TAB – PHYSICIAN ORDERS
ADULT ICU ALCOHOL WITHDRAWAL PROTOCOL ORDERS
MEDICATIONS
4. ADDITIONAL MEDICATIONS
C. ADDITIONAL THERAPY – continued
❑ Dicyclomine (Bentyl) 20 mg PO every 4 hours PRN abdominal cramps ❑ Methocarbamol (Robaxin) 1 gram PO every 6 hours PRN muscle pain D. TREATMENT FOR ALCOHOL WITHDRAWAL – Physician to select treatment
i. Oral medications will be initiated on patients tolerating oral intake unless otherwise specified by the ii. Hold Ativan/Valium for any of the following: excessive sedation, oxygen saturations less than 92% on room air, Systolic Blood Pressure of 90 mmHg or below, Diastolic Blood Pressure of 60 mmHg or below, iii. CHOOSE ONLY ONE – DIAZEPAM OR LORAZEPAM TREATMENT:
❑ MILD ALCOHOL WITHDRAWAL PROTOCOL CIWA-A Score 10 to 14
Lorazepam (Ativan) 1 mg IV / PO 3 times daily x 24 hours; then Lorazepam (Ativan) 1 mg IV / PO 2 times daily x 24 hours; then Lorazepam (Ativan) 1 mg IV / PO x 1 dose in AM, then discontinue Lorazepam (Ativan) 1 mg IV / PO every 4 hours PRN for CIWA Score of 10 to 14 or Blood Pressure greater than 160/100 mmHg or heart rate greater than 100. ❑ MODERATE ALCOHOL WITHDRAWAL PROTOCOL CIWA-A Score 15 to 19
DIAZEPAM (VALIUM) – Recommended 1st Choice of Treatment
Diazepam 5 mg IV/PO every 6 hours x 4 doses (hold for excessive sedation), then Diazepam 5 mg PO every 8 hours x 3 doses, then Diazepam 5 mg PO every 12 hours x 2 doses, then Diazepam 5 mg PO every AM x 1 dose, then discontinue For elevated blood pressure and/or pulse only: Diazepam 5 mg IV every 4 hours PRN
OR ❑
LORAZEPAM (ATIVAN)
Lorazepam 1 mg IV / PO every 4 hours x 6 doses; then Lorazepam 1 mg IV / PO every 6 hours x 4 doses; then Lorazepam 1 mg IV / PO twice daily x 2 doses; then Lorazepam 1 mg IV / PO x 1 dose in AM, then discontinue TREATMENT FOR SEVERE ALCOHOL WITHDRAWAL ON PAGE 3
continued on page 3
PHYSICIANS ORDERS
LEE MEMORIAL HEALTH SYSTEM
Lee County, Florida
ADULT ICU ALCOHOL WITHDRAWAL
PROTOCOL ORDERS
FM# 3354 Pub. 08/13 Page 2 of 3
UCO TAB – PHYSICIAN ORDERS
ADULT ICU ALCOHOL WITHDRAWAL PROTOCOL ORDERS
MEDICATIONS
4. ADDITIONAL MEDICATIONS
D. TREATMENT FOR ALCOHOL WITHDRAWAL – continued
❑ SEVERE ALCOHOL WITHDRAWAL PROTOCOL
CHOOSE ONLY ONE – LORAZEPAM OR DIAZEPAM TREATMENT
❑ DIAZEPAM / VALIUM – Recommended 1st Choice of Treatment
Diazepam 10 mg IV / PO every 6 hours x 6 doses, then Diazepam 5 mg IV / PO every 6 hours x 6 doses, then Diazepam 5 mg IV / PO every 12 hours x 2 doses, then OR ❑ LORAZEPAM / ATIVAN
Lorazepam 1-2 mg IV every 1 hour PRN withdrawal symptoms while awake x 24 hours starting now, Lorazepam 1-2 mg IV / PO every 8 hours x 48 hours, then Lorazepam 1-2 mg IV / PO daily x 24 hours ❑ Lorazepam _________ mg PO every _______ hours PRN agitation in addition to scheduled doses.
May continue after scheduled doses completed.
ADDITIONAL ORDERS
Physician Signature: __________________________________________________________ Date:________________ Time:________________
Physician Printed Name: ______________________________________________________ Physician Number: _________________________
PHYSICIANS ORDERS
LEE MEMORIAL HEALTH SYSTEM
Lee County, Florida
ADULT ICU ALCOHOL WITHDRAWAL
PROTOCOL ORDERS
FM# 3354 Pub. 08/13 Page 3 of 3
UCO TAB – PHYSICIAN ORDERS

Source: http://www.leememorial.org/FormsManagement/PDF/PhysicianOrders/CriticalCare/3354AlcoholWithdrawal.pdf