NU 124 Case Study on Alcohol Dependency and Alcohol Delirium
Admitted to a local hospital via ER after calling for an ambulance due to complaints of “chest pain. Also
reported that he had been “drinking for a long time”.
Hx: 47 y.o. male, HIV+ and Hepatitis C +
Assessed ER using CWA. Orders: Ativan 2-4 mg IV Q 1 hr times 3, IV fluids with Thiamine and
Multivitamin, NPO. Transfer to Cardiac Telemetry unit to monitor chest pain.
Telemetry: 11PM Assessment - HR 110 to 120, unable to follow commands to only get up to BR with
help, restless, agitation and confused.
One hour later. Restlessness increasing. MD: Increase Ativan to 4mg IV Q 1 hour times 3. Nursing
assessment after medication administration – no change in patient symptoms. MD notified and Ativan
increased to 8mg IV Q 1 hr times 8.
Patient medicated. 12 midnight, Hr 140, extreme agitation and unable to sedate. MD notified. Valium
given IV push. Order to transfer to ICU. Assessment at 1AM – HR 170, moderate sedation, respirations
“OK”, supraventricular tachycardia.
2:30AM transfer to ICU: Ativan IV drip of 15mg per hr. Still tachycardic. Goal: to paralyze for sedation
and place on a ventilator.
Before pt could be intubated, he coded – cardiac arrest. Respiratory SO2 = 70. Unable to now intubate.
Emergency tracheostomy performed for mechanical ventilator.