Because it takes only a minute or two to administer, the scale can be used as frequently (i.e., every 1-2 hours) and can be used early when alcohol withdrawal is viewed only as a clinical risk.Īny other research in the pipeline that you’re particularly excited about?Ī number of studies have examined the use of various benzodiazepines other than diazePAM for treating alcohol withdrawal. The CIWA-Ar should used in all patients suspected of being at risk to have alcohol withdrawal. How do you use the CIWA-Ar for Alcohol Withdrawal in your own clinical practice? Can you give an example of a scenario in which you use it? Detailed histories, careful clinical examination, and urine drug screens can help sort out more complex patients. Management of patients today is potentially more complicated than it was when the CIWA-Ar was developed because of a very high incidence of other drug abuse. Patients or standardized trained patients can be used to ensure good staff agreements on ratings. We did not emphasize the importance of standardized training of all staff and the usefulness of the assessment of within and between rater reliability in the paper. Our original paper still accurately outlines the reasons for using the CIWA-Ar and how to use it. What recommendations do you have for doctors once they have applied the CIWA-Ar for Alcohol Withdrawal? Are there any adjustments or updates you would make to the score based on new data or practice changes? With training, nursing staff can readily and reliably perform scoring, but the score should not be used to drive "standing orders". Our typical management has been to use diazePAM loading ( Sellers 1983). While scores of 10 or less rarely need pharmacologic treatment, clinical judgement is still very important with scores between 10-20. The most common misinterpretation of the CIWA-Ar Score is that it is a recipe for when to use pharmacologic treatment. Almost 30 years after we published this paper, I still get approached about its implementation. There are some very good YouTube videos that are useful for training, such as this one. The CIWA-Ar has been translated into more than 20 different languages and is used very widely. What pearls, pitfalls and/or tips do you have for users of the CIWA-Ar for Alcohol Withdrawal? Do you know of cases when it has been applied, interpreted, or used inappropriately? This program to improve recognition and treatment of alcohol withdrawal was conducted because of a lack of validated diagnostic and clinical monitoring tools that could guide and improve treatment. The CIWA-Ar is a shortened version of a previous 15 item scale CIWA (see Sullivan 1989). Why did you develop the CIWA-Ar for Alcohol Withdrawal? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |