NSER 7210 - Mod 2 – Questions with Solutions
Describe the stages of alcohol withdrawal syndrome, and the timing since last drink - -
Minor: 6-12 hours (Tremors, sweating, nausea, tachy)
Alcohol hallucinosis: 12-24 hours (Dysperception)
Alcohol withdrawal seizures: 24-48 (Seizures)
Delirium tremens: 48-72 (psychosis, hallucinations, seizure, coma)
-What is the "gold standard treatment" of alcohol withdrawal - -Benzodiazepines
-What are the symptoms of alcohol withdrawal - -Autonomic hyperactivity - Agitation,
tremors, irritability, anxiety, hyperreflexia, confusion, hypertension, tachycardia, fever,
diaphoresis,
Severe: Hallucinations, Seizures, psychosis, coma
-Briefly describe the mechanism of EOTH withdrawal - -ETOH causes CNS depression
through enhanced GABA activity. Chronic ETOH causes reduced function and number of
GABA receptors and upregulation of NMDA receptors to achieve homeostasis.
Abrupt cessation causes hyperexcitability due to impaired GABA (inhibition) and increased
NMDA (excitatory) functioning
-What is the "Kindling" theory of alcohol withdrawal - -Those with repeated episodes of
alcohol withdrawal syndrome have an increased neuronal excitability and sensitivity,
meaning they are at risk of progression to severe withdrawal
-Who is at risk of severe alcohol withdrawal syndrome? - -Those with repeated episodes
of AWS
Medications that mask early symptoms (beta blockers)
Severe illness increases risk of severe AWS (pneumonia, coronary heart disease, liver
disease, anemia)
-Describe the general treatment plan of alcohol withdrawal syndrome - -Reduce stressors:
Gentle reorientation, quiet room, gentle lighting
Correct fluid depletion, hypoglycemia and lyte and vitamin disturbances
Benzo's are only med with proven efficacy, several others being studied (Sodium oxybate,
propofol)
Potential adjuncts (Beta blockers, barbituates, clonidine, gabapentin, neuroepileptics)
-Define SIRS - -An overwhelming, unregulated inflammatory response
Results in uncontrolled coagulation, widespread vessel leakage, poor distribution of
circulating volume
-Explain qSOFA for assessment of Sepsis - -Quick Sequential Organ Failure Assessment
RR >22
Change in mental status
Describe the stages of alcohol withdrawal syndrome, and the timing since last drink - -
Minor: 6-12 hours (Tremors, sweating, nausea, tachy)
Alcohol hallucinosis: 12-24 hours (Dysperception)
Alcohol withdrawal seizures: 24-48 (Seizures)
Delirium tremens: 48-72 (psychosis, hallucinations, seizure, coma)
-What is the "gold standard treatment" of alcohol withdrawal - -Benzodiazepines
-What are the symptoms of alcohol withdrawal - -Autonomic hyperactivity - Agitation,
tremors, irritability, anxiety, hyperreflexia, confusion, hypertension, tachycardia, fever,
diaphoresis,
Severe: Hallucinations, Seizures, psychosis, coma
-Briefly describe the mechanism of EOTH withdrawal - -ETOH causes CNS depression
through enhanced GABA activity. Chronic ETOH causes reduced function and number of
GABA receptors and upregulation of NMDA receptors to achieve homeostasis.
Abrupt cessation causes hyperexcitability due to impaired GABA (inhibition) and increased
NMDA (excitatory) functioning
-What is the "Kindling" theory of alcohol withdrawal - -Those with repeated episodes of
alcohol withdrawal syndrome have an increased neuronal excitability and sensitivity,
meaning they are at risk of progression to severe withdrawal
-Who is at risk of severe alcohol withdrawal syndrome? - -Those with repeated episodes
of AWS
Medications that mask early symptoms (beta blockers)
Severe illness increases risk of severe AWS (pneumonia, coronary heart disease, liver
disease, anemia)
-Describe the general treatment plan of alcohol withdrawal syndrome - -Reduce stressors:
Gentle reorientation, quiet room, gentle lighting
Correct fluid depletion, hypoglycemia and lyte and vitamin disturbances
Benzo's are only med with proven efficacy, several others being studied (Sodium oxybate,
propofol)
Potential adjuncts (Beta blockers, barbituates, clonidine, gabapentin, neuroepileptics)
-Define SIRS - -An overwhelming, unregulated inflammatory response
Results in uncontrolled coagulation, widespread vessel leakage, poor distribution of
circulating volume
-Explain qSOFA for assessment of Sepsis - -Quick Sequential Organ Failure Assessment
RR >22
Change in mental status
