code blog: tales of a nurse

I'm always enlightened by your posts. Keep up the great work (on-line and off)! :')

Who pays for ICU for detoxing an alkie? Do these people have private insurance or are the taxpayers footing the bill? Just curious because I haven't worked in a hospital for years and have not heard of detox in the ICU.

"Detoxing an alkie" in ICU is pretty standard practice these days. DTs are considered a medical emergency and ICU is usually required. "These people" many times have medicaid or medicare (quite commonly they also have VA benefits), but most of the time are uninsured. I'm just glad to know that someone like you, Suzi, is not in charge of their care. The tone of your entire comment just smacked of judgement and superiority.

And a tip, Geena...in Detox and Psych we automatically DOUBLE the amount of alcohol intake. For drug addicts, we automatically DIVIDE IT BY HALF.

You know, when caring for someone in detox I wonder how effective it would be to videotape (obscuring the face, etc ...HIPPA ya know), during some ot the tirades ---and torment they are going through---for clearly they are tormented and suffering. I just wonder if sowing videos like this would do anything to help people with a) stay away from liquor if they have the risk factors for addiction; b) help keep someone who has successfully detox's stay free of alcolho; and or c) show it in every highschool at the beginning of each term. Don't know if it would have much impact beyond enlightenment --- I guess after that it's choices. It would be helpful for family memebers you unwitingly assist in prolonging the addiction---these co-dependents need education and assistance also. It's an emotionally and physically wrenching experience for EVERYONE, and I am sure that only about 1/100th of the population is aware of this. I wasn't until I started working in ICU. what an eye opener. Thanks, Gina (Geena) for bringing this subject to light.

Here's a tip for detoxing ETOH addicts: Propofol.

Fast knockdown, highly titratable, works on a different metabolic path than benzos (which are broken down in the same path as ETOH, which is why you have to use so much lorazepam/diazepam to get them cooled off), and fast to reverse if you go over the top.

Yeah, you have to monitor them closely, and you may end up intubating them. But you have to do that anyway with the amounts of sedatives you're giving now, so why not use something that works right away while waiting for the haloperidol (a better drug for controlling the psychosis/delirium of withdrawal, IMHO) to get therapeutic?

Tracy, umm... whose comment sounded judgemental? I asked for information and you made an assumption because you didn't like my wording. I'd say that was a lot more judgemental than what I said.

As a professional, I never let my biases or personal opinions affect my nursing care. If you assumed otherwise, then you are wrong. I don't know if you read Chris Rangel's blog, RangelMD, but he talks about those issues sometimes. We are all human and have opinions but that does not mean we let them interfere with our professional behavior.

It doesn't bother me as much to detox people that willingly come in for that purpose. Detoxing patients that do not wish to be, however, is very frustrating. We get a lot of "frequent fliers" in because they've been found in the park unconcious. It is maddening to detox "those people" because they do not have insurance and are practically wasting at least $20,000 for every admission. Furthermore, they take up ICU beds and staff. We transfer them, and they come back in a few months and we do it all over again. I agree with Suzi in that we as nurses all have biases against certain patients, but we do our jobs to the best of our abilities anyway.
It is my opinion that detoxing alcoholics against their will is counterproductive and a waste of resources. BUT WE DO IT ANYWAY, and we do a good job.
It's hard to feel compassion towards someone who has just tried to kick your skull in.
And Alwin, I would LOVE to Propofol these patients, but our docs would never ever ever go for it. A bottle of Milk of Amnesia comes bundled with the endotracheal tube, and under no other circumstance. I think hell would freeze over before they'd reconsider.
I'd be interested in hearing your experiences with it, though.

A couple of years ago I had the extensor tendons torn off in my fingers by an ETOH patient we were trying to knock down with lorazepam. I had jokingly later said that I could have put him down in 60 seconds and kept him that way with a bottle of propofol. The doc, a cardiologist, raised her eyebrows and asked why I hadn't asked her for some?

I had the same assumption that your docs had, of course: propofol = intubation. The more you think about it, though, the stupider it sounds. It's used for concious sedation in the endoscopy lab; I don't think they tubed the president for his 'scope when the ran his colon last year. The doses of benzos we give can require intubation, and they sure as heck aren't as titratable. Ativan takes a helluva long time to reach peak effect even IV. Why not give a drug that, if you err on the high side, you can turn off and have them recover in 15 minutes?

Caveat: it's a 1:1 procedure, requires staff aware of the kinetics of the drug, and excellent airway management skills. That being said, there is nothing like having a patient go from swinging from the IV stands to sleeping under the White Cloud of Forgetfulness in 15 minutes. It reduces the risk of injury to the patient and staff.

In the hands of the properly experienced and paranoid nurse clinician, Milk of Amnesia for DT's is doable in the ICU (and no other place).

i work for the VA (not the hospital...benefits) and i truly admire all of you nurses and doctors for what you do every day. i "see" the veterans (many of whom have Etoh and ivda addictions) and i'm already intimidated at times even though i only see their files. keep up the good works and my prayers are with you ... sometimes it takes divine (supernatural, what have you) intervention to change the person for good. i actually pray for veterans (esp. terminal cases on my desk) sometimes as i work. in any case, this entry was most enlightening, and truly medicine (at every level, in any and all positions) is a calling. much respect and best regards to all of you.

wow! drama on my sister's blog :)

anywho, my observations on addictions:

peer pressure works more then just showing people a video of what could happen to them.

i think it's kind of like brainwashing in a way. you have to pound it into the addicted's head that the drug they are using is unacceptable.

beneficial drugs certainly help to make the "brainwashing" easier. i sure coulda used a detox from smoking if there wasn't welbutrin and the patch to help me through.

um, well. the psychological addiction is a whole other monsterous thread. go G! queen of the physical addiction breakers!

Geena, where were you when I had to wean my patient off narcs? I swear, I felt like the methadone queen.

I am a recovered addict/alcoholic and also have had a 33 year career in the medical field. From working a detox unit in the late 60's and early 70's, when I realized I had a problem I was absolutely terrified to ever run out of what I needed. Fortunately I survived to see the other side of the coin, which is this: after I bit the bullet and did detox, the memory of the misery and terror, not to mention what I know intellectually concerning the physiology of the thing, has kept me clean and sober 18 years. And counting.

A poet (I think it was Emily Dickenson) once said "If I can keep one heart from breaking, I shall not have lived in vain." I congratulate you on setting your feelings aside and waging the uphill battle. A few of us DO appreciate it, go back thru that revolving door, and return to productivity in society. Without you I would certainly be dead by now, instead of saying "thank you" in my own way.

Thanks for the stories and other's comments on the message board. I am fairly new in the home health care field and had an assessment for a gentleman who is detoxing (not by choice but due to an illness) from alcohol. I hadn't heard of ETOH, and pulled your site up on a search. Thanks again...the info here helped me prepare.

I'm an RN working in CTICU in NYC and the amount of Functioning ETOH patient that have heart Surgery is mind blowing. The most difficult part is we never know the are ETOH because they truely don't know they are. We don't look to detox but to extubate, and that can take up to three days. It's so difficult managing these types of patients. The Doctors always want to blame the Nurse for keeping the patient intubated, but as soon as you lighten the propofal they are hypertensive, tachycardic and over breathing the ventilater. I want to find out is there a faster way to speed up the extubation process on these patients?

NYC CTICU RN, waiting for reply, Thanks!

I was dumped into a drug ward under the suspicion that I was drunk without being told where I was going. I was not drunk. I was given benzodiazepene the first night I was there. Even though my blood alcohol was 0.0000 the nurses in this place insisted I was reeking of alcohol, and blacking out and everything, without checking in or even asking me if I was first. The only thing they found in my blood was a benzodiazepene which they gave me! They tried to insist that I took it although I do not take drugs like these! I drank only moderately before entering this ward. I had been drunk only on rare occassions because yes I was in college, and I had been to the odd party. The way this place had me pegged as an "alkie" you'd think they had the power to lock up whole colleges. You know what I drank before entering detox. 2 Zimas three days before entering detox! The twat nurse who admitted claimed I drank every day without asking me if I did! I feel my experience in detox caused me tremendous emotional damage and isolation since alcohol wasn't my main problem. The message the place sent me was my problems are too fucked to deal with, and it's better to by into being dependent on what they call me, even if it's highly exaggerated. I feel this detox played on expensive game with my health by some of the medications they gave me and the responses I had to the meds. They were so stupid that they couldn't even see that the twitching and tremoring I had was a response to the Paxil, Navene, and Depakote, as well as valium, they gave me. I felt I needed to detox after leaving this insane place. This experience has destroyed my trust in the helping and psychiatric profession.

I'm seeking help for a friend and need to find a Housptial or place where we can put him cleaned out. Can you help me help him.thank you.

Thanks to many who take this not as some joke but with understandingand compassion.I too had to go into at a very young age and not my idea but when you don't taper off a pt from any benzo, it can be a nitemere. Tho we also have to understand that we don't have enough info about this type of detox, only for the alcoholic. I never again touched any benzo and was given it when it first came out. The therapy field is so wrong on continuing these drugs pass the time of use. The length that should be given at the most 2 weeks they are not long term and yes work fine (sorry well here in Ca they do if the person is in a good place that knows how to detox the alcoholic the person who comes off fast from benzo that another story.) Its sick how now my mother after 54yrs of taking pills and the same for the male here, taking pain pills as well is so out of hand that where the prob lies is for my mother because no one uderstands the detox of a person on benzo for that many yrs and let me tell you, never go help if you dare see one thing that shows they don't want help. When there sick and tired as my mother finally did, yet now is stuck on all these antidepressants, when she needs a tranq for a time and tho sure she had to do her slow detox, tho for her fear to get off and sure you have too yet she ended up off and now as the UK had a conference if you aren't a skitso, (sorry not looking up the word)Im to sick to really care tho mean no disrespect and sorry am just tired. The conference was open to the public and sad it was in England and all the well known doctors and all understanding that if you take a antideprssant and don't need it you will become what the papers on it tell us. Its not for the user of benzo, they get off the detox with pheno and I did but if you go back on you will feel that horrible result of rebound, which my friend who was a thrapist at the time told me that her mother as well as mine both had the rebound and it is pure hell. Im grateful that I got off once and only once 30yrs later, was given again for a short term only but of course turned into a 3 month time, so I did my own detox sorry it was a pure hell of nothing, could of stopped my heart but to me to be rid of that drug out of my body even only on it for maybe 3months to calm me down as the doctor told me and since knowing him for so many yrs there was trust their, not all of us turned into addicts thank God and now. I came to my family's house 3yrs ago, healthy, and did it because after my mother, buying them working doctors and finally find she couldn't get that same high and it turned in to a nitemere her rages and all. I came and ended up with edema indentation, and now after my doctor tho sure he stated was a pulminary internist, his lic revoked and never to get it back the same with his friend in the next city, tho he killed one pt, its ok in CA and Hawaii all that happens is your lic is taken and it shows neg on that pt, no criminal charge and you just hit another city or if your smart make it small. People please check out on the net every doctor you go to and what is sad most don't even get report of so many wrong things. Its public record and for 2yrs with no air to my lungs, and given pain pills, and a muscle relaxer. Nothing else I ended up always telling him what I wanted and he refused water pills, when telling him I could not breathe and all he would tell me was 'I know it is so hard to understand, tho sorry all he wanted was the insurance money, the hard part is when you live with your parents in a rich area tho were not rich, there isn't much unlesss your lucky or I call it blessed to find one doctor at our better area where he works at the best hospital around. I finally got sick and tired and never used maybe in 2yrs after a cat scan as well from a family friend who of course was retiring and with living under the care of addicts its been pure hell. sorry I get sometimes side track from the edema and lack of oxygen to my head, tho my long term is great and short term most of the time. I did take maybe out of the 3yrs 3 extra strength vicoden and sad but can't sleep laying down or either their is no air or I sceam in such pain from the muscle touching whateverside Im laying on. So sleep for me is hard and as you see I will drift off for an hr then its up the rest of the time, I find out he is a herblist and was warned by thanks to some angel in 7-11 who is chief of staff of cardio at our better hospital our meeting saved my life. He flipped when I asked him was it ok for me to take a inhaler ashma steroid. He told me won't repeat but such harsh words and said,"What is this man trying to kill you, you never give a pt with edema ashma inhalers. He was right and so glad I was able to run into him, after seeing so many well lets say its sad the medical field in this rich area and fine now that after I ordered him to take a lung xray that now have diseased lungs and sorry there isn't much you can do but make someone comfortable and finally somehow Im getting my minibox of oxygen to carry with me so I can leave this house of hell. I never thought when sorry but worked and trained for them and Kaisers here are drug happy, have seen it so many times and there death rate is high, tho people till they go through it just love them and some don't even understand how wrong they are. My mother who I never got to know the real one, she was always so happy, (Yes those benzo will do that) till finally she got so out of hand and started in on violence and had to be taken to so many psych hospitals and on and on she is addicted and even getting clean now she is 72yrs and its sick that they now have her on not one but 2 seperate antidepessants. She is now and told her not to take Navene because she is not paranoid and if taken can become irrevisable and with her side effects also Trazadone, there was a meeting in England that the public was invited to that so many of our and there top doctors attended and how I got invited who knows but it got me to look over and they said we have become so wrong in giving out all these drugs that, what did we do over 30yrs ago, when the drugs then that were popular back in the early 60's were pheno and it became so addictive that is when Valium arrived and now the new gentation is xanax I now just deal with the pain and with being beaten from the male his being on pain pills with the somas as well for over 53ys he now goes into rages tho he always did and all his life took something as my mother did as well. My sister Im afraid to stay in the industry of Hollywood, Ca she has to take coke and sorry or as they say her friends won't accept her and for her to even come back at 50yrs lol here to help out shows that once again tho Im not mad only understand more that all addicts are selfish and thanks to all seeing so many family members friends and only now one who is clean and sober but either there dead, and this includes street drugs because they too will hit the detox wards of the hospital because funny this rich area has nothing for any type of probs and if your beaten sorry you leave and the police do nothing but believe the addict and oops yes they lie as was told all my life my mother never lied. Sorry she lied and still did when never thought after hearing all my life how the male here beat her and she him and then tells the police I just drop in and they told me after being hit on the head with a heavy bottle of starbucks coffee and broken thumb, that I had to leave, when I said,"gee do you go home and hit your wife and then told him sorry when my check comes I will leave tho could not was so weak and now thank God tho it seems like daily something goes wrong and the male here hates me and asks me daily when are you getting out as if I want to stay you would think he would drive me around to the drs in his new car, but when you can't drive from weakness and no air to lungs all you can do is stay in a room for now its been going on 4yrs and finally unless another thing happens, I get my oxygen, will then finish up finding out how long I have to live and then live my life out where I left it in our Capital with all that you could want in medical help. Its Sacrameto, we make doctors at UC DAvis yes Im so please and its sad now to see my mother ruined and who she is now is a product of antidepressants when that is not what she heeds she has tried everyone per the kaiser foundation and they have given up on her but it was all for the profit from the drug companies and It sickens me, she always needed an internist to deal with her probs. NOt the psych that tho I will not speak to the male here he gets set off and I just stay in my room leave once a week to get food in a drive a block away and he being 72rs and so hateful and brags how he is so well and funny even tho he curses God he is scared and looks back at his whole life I was a mistake and he is not my father he and her never bother to get any form of therapy except when I was 5yrs and my mother wanted to make sure that what they did in front of me since I was a tiny baby hadn't effected me, The Dr. told them that "She has a high IQ at 5yrs and its the two of you who need help." They never got it I left home at an early age and lived with my boyfriend and it was to really escape all that drugs can do to so many and now that I love to live alone and now that I should of stayed where I was, but when its your mother you go and sorry not anymore and she now could care less am told as she is now afraid he will leave her which its like some soap opera, if people had understood the idea of how to detox a women on benzo is diff then a pysch pt and it will be till someone understands there two seperate areas. She now yells at me and I see bits of my real mother and remember who at 3yr making cookies togehter and lol tho sure she was on something and yes pheno and sad a beatiful female now who husband has a women who has waited for him now for over 30yrs I think to myself go and its all because he will but is waiting to put my mother soon in a assisited living arrangement and then off he goes with the money and I have tried to tell her. Even tho I have pics of all the beatings and can hear his say because this is all they think about any addict induding the ones on the psyh drugs as well that he tells me "If you do anything to mess up my pain I will kill you." My sister on the street drugs and sad because her whole life she spent trying to get in with the stars life and only did the industry till now after all her parties and sure I have met stars and lived down their and it so infested that the police look away and gee some even do it as they do it here. All for what she is now 50yrs and has OCD and sorry since I told her off and she ran this house for yrs we haven't spoken since 6 yrs out of guilt she wants me gone so he is rushing me out to please I guess his real daugher and Im just thankful that sure will be an adult and when I can leave at my time not their's and be gone and live in peace. Just an FYI, I have been around pills all my life, took nursing tho only a LVN and did many fields of work. my fav is working with the youth and hear it from NY to CA that "were sick of our parents when all we want is to be loved and hugged and all they do is give us things." So I gave um all a hug and told them to just get to school and learn from it all and try to show their parents how to love as it seems they don't know and we wonder why we find young ones in detox well here it is part of the prob. Just my opinion..Drugs if not used right will distroy and that was one more thing they told me "we won't do drugs or parents do and these are well to do parents so you see its more then just a small thing. I only pray that I get some kind of fun before I get any worse and yes I feel it but what more can I do , I have had it with no help and sorry not angry only hurt and soon will be gone to live once again in peace and with finally friends all new ones. People leave when your sick so its ok, you have to try to see thing through their eyes. I love all and try and show it and that way no matter what goes on here Im at peace so important for me to stay that way till Im gone. well thanks for reading . I have no one and yes it gets lonely but its ok, soon somehow I will be gone when I get that box of life.
God bless you all and hope it helps to see another side that so many don't understand but put together because the nurse don't even know lots of times what to do. We need more education to make it clear that these are two separate situations detox of a benzo and detox of an alchoholic or heroin addict. It can take sometimes up to 8yrs to get all of the drugs from benzo out of the muscles and all so see there two seperate things.
Merry Christmas all.
Kathy

PS; Im sorry so tired after rereading this whole mess, just hang with me and try to see that being so tired you really are not up to write things in proper grammer or even spelling. I hope you can forgive me but wanted to show my side to all and if you need to mail me to ask anything on addiction or pills/st drugs. Im will answer all. I know tho it hurts but was told should of worked in pharmacy work:) lol. No to much hurt everytime I see a pill now days. I just want to live my life away and its hard not knowing how to be sick since all my life I have always been in perfect health till you will get sick living under stress. Once again thanks for my PS and trying to understand what I even wrote at 5:00 am and finished it just a bit ago on my last post.:)
Thanks,
Kathy

Hi! I googled the term 'ETOH' and your blog came up. I'm a female Army Veteran. and I was thumbing through my old records there was statment by the PA on my final med exam that I didn't have a clue what it meant "ETOH - denies." what does that mean?

how manny lorazapane will it take to kill. Have already taken a lot, but just go to slrro, ans feel fuzzy.

what happens when a patient comes in for detoxification to the ER? Also, do the doctors give the person something to calm down?

I am a detox nurse and also work a residential treatment unit - we are a social detox even though we have nurses on duty. I have many stories that would curl your hair.
The worst is working with most of the other nurses in this facility. I think that my favorite unit is the Short Term residential treatment unit or the dual diagnosis unit. Detox not so much.
Civil Protective custody and Emergency protective custody not so bad.

I am an RN at a small hospital in rural Montana. We cover the ER and the floor. I graduated a little over a year ago and this week was my first time working w/ETOH detox. I am learning from your experiences. Thank you. Sending love.