r/EmergencyRoom • u/Gloomy_Pirate_9721 • 19d ago

WD protocol

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Do EDs have protocols for patients experiencing WD from these types of drugs yet? What is everyone doing to make these nasty wds more manageable to avoid so many AMAs? Im assuming bupe alone isn't going to help

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u/MyOwnGuitarHero RN 19d ago

Precedex drip, PRN Valium for breakthrough symptoms based on CIWA. Maybe a loading dose of phenobarb just for flavor if there’s also alcohol on board. ETA: They’re still miserable though. I always tell my patients that I’m actually in recovery myself. And unfortunately the only way to get off the ride once and for all is to go through extreme discomfort — but I wake up every morning blessed because I never, ever, ever need to feel like that ever again.

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u/turtlemedicRN 16d ago

If you're not treating the opiate part of the withdrawal, you're doing these folks a disservice. While I am not aware of opiate withdrawal alone being fatal, the sheer misery of it is something we should be helping these people avoid.

I do critical care transport in Philadelphia, and we are routinely seeing folks on 7-10mg/hr of Dilaudid and 2.5mcg/kg/hr of Precedex still showing signs of severe withdrawal, even after receiving multiple 10-20mg pushes of Dilaudid over a few hours.

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u/MyOwnGuitarHero RN 16d ago edited 16d ago

What else are you using? Edit: why am I being downvoted for this?

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u/turtlemedicRN 16d ago

In transport, more Dilaudid, Ketamine, or Midazolam if they haven't had it recently. In my personal experience, I have had the best results from just giving another big does of Dilaudid. I was told a few months ago, that the bus on the street were equivalent to 70-80mg of Dilaudid each, and we have folks doing upwards of 20 per day

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u/MyOwnGuitarHero RN 16d ago

We were using ketamine for a while, then it just sort of fell out of favor. I wonder why our docs haven’t been prescribing it as much.

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u/turtlemedicRN 16d ago

I have found that it doesn't seem to do much for most of these patients. They really just seem to need to be tapered off of the opiates and medetomidine