Alkohol og abstinenser på akutafdelingen - gør vi det godt nok?

Baggrund: På akutafdelingen møder vi ofte patienter med et skadeligt alkoholforbrug. Behandlingen af deres abstinenser kan være kompliceret, og ikke ufarlig. Med baggrund i flere indberettede utilsigtede hændelser vedr. overdosering med Klopoxid, blev der i førsteforfatterens akutafdeling udarbejdet en instruks, der kunne støtte læger og sygeplejersker i behandling af alkoholabstinenser. Formål: Formålet med denne artikel er, at føre læseren igennem vores studie og tydeliggøre vigtige resultater. Desuden ønsker vi at inspirere til tværfaglig refleksion i egen klinisk praksis. Metode: Ved hjælp af metodetriangulering blev data fra audit af 10 konsekutive udvalgte journaler og 27 spørgeskemaer udfyldt af afdelingens sygeplejersker sammenholdt og analyseret vha. statistik og indholdsanalyse. Resultat:Resultaterne viste tydelig diskrepans mellem sygeplejerskernes opfattelser af egen praksis og reel klinisk praksis. Ingen journaler opfyldte alle de målte indikatorer, og opfyldelsen af de enkelte indikatorer var meget svingende. Sygeplejerskerne italesatte instruksen som tvetydig og mangelfuld på flere områder, men også som et vigtigt redskab i deres daglige arbejde. Konklusion:Behandling af abstinenser hos den alkoholafhængige patient er vanskelig og var særdeles mangelfuld i de 10 analyserede journaler. Sygeplejerskerne opfattede primært instruksen positivt, men dette modsvarede ikke resultaterne fra auditten. Abstract: Background:In the emergency department, we often meet patients with harmful alcohol consumption. The treatment of their withdrawal symptoms can be complicated and harmful to the patients. Based on several reported unintended accidents regarding overdose with Chlordiazepoxid, first writer's emergency department made an instruction to support doctors and nurses in the treatment of alcoholic withdrawal symptoms. Aim:The aim of this article is to guide the reader through our study and clarify important results. In addition, we want to inspire to interdisciplinary reflection in the readers clinical practice. Method:We compared data from audit of 10 consecutive selected journals and 27 questionnaires completed by the department's nurses by using method triangulation analyzed statistically and by content analysis. Result:The results clearly demonstrated discrepancy between nurses' perceptions of their own practice and data from the audit. No records met all the measured indicators, and the performance of the individual indicators was very fluctuating. Nurses described the instruction as ambiguous and inadequate in several areas, but also as an important tool in their daily work. Conclusion:Treatment of withdrawal symptoms in the alcohol dependent patient is difficult and was particularly inadequate in the 10 analyzed records. Nurses primarily perceived the instruction positively, but this did not match the results of the audit.

Persistent dysphagia and drowisness following collapse in an alcohol-dependent patient (Answers)

This T2 weighted MRI scan demonstrates a hyperintense trident shaped lesion extending from the pontomedullary junction to the midbrain with peripheral sparing (figure 2 – abnormality indicated by white arrows).

Persistent dysphagia and drowisness following collapse in an alcohol-dependent patient

A 58 year old man was brought to the emergency department with acute confusion after being found unconscious on his floor at home. He had a background of alcohol misuse with alcoholic liver disease. He was not taking any regular medications. On examination he smelt of alcohol and was tachycardic at 96 bpm with BP 110/70. The patient’s Glasgow Coma Score was 14, being drowsy but responsive with bilateral lower zone crepitations on auscultation of the chest. Neurological examination revealed generalized reduced muscle bulk but no focal deficits.