Your next psych patient may need detox help

Clinical TipsAt Emory Johns Creek (GA) Hospital, ED nurses have noticed that many patients with psychiatric complaints actually are looking for help with drug and alcohol addictions, reports Mickey White, RN, BSN, MBA, director of the ED.


"With alcohol, they usually tell us they are looking for help. With drugs, they either tell us, or they come in as an overdose," says White. "However if they come in as an overdose, they usually get admitted to the hospital before they can be transferred to a psychiatric facility."

Patients might tell the triage nurse upfront that they need help with an alcohol addiction. "They usually have lost their job or family and don't know where else to turn," says White.

If a patient tells you this, White says to ask these questions: When was the last time you have had a drink or taken drugs? How much and how often do you use alcohol or drugs? Have you ever been through detox before? Do you have thoughts of wanting to harm yourself or others?

"Have labs done first, including drug and alcohol labs, to rule out any other medical problems," says White. "Sometimes benzodiazepine is given if the patient is agitated."

After one patient waiting for placement into a facility for alcohol detoxification had been in the ED for almost 24 hours, he went into delirium tremens due to alcohol withdrawal.

"An astute nurse noticed the increasing tremors, sweating, and change in the patient's mental status," says White. "She notified the ED physician, and an order for lorazepam was obtained. Continued reassessment and appropriate medication prevented deterioration, and the patient was eventually safely transferred to another facility."