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Southern Health Partners, Treatment Protocol - Detoxification Signs and Symptoms

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Southern Health

I Partners

You r Partner In Affordable Inmate Healthcan

TREATMENT PROTOCOLS
Medical Department – County Jail

DETOXIFICATION
SIGNS AND SYMPTOMS

Treatment Protocols – Revised May 2014 – Revised November 2014- Confidential Work Product of SHP & Physician
Not to be a substitution for prudent medical judgment
Page | 9

SHP 000340

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I Southern Health

Partners

You r Partner In Affordable Inmate Healthcan

TREATMENT PROTOCOLS
Medical Department – County Jail

ALCOHOL DETOX
Please notify physician/provider before initiating protocol
Initiate Alcohol / Drug Withdrawal Flow Sheet Form. Complete CIWA form.
Alert officers of status, and have them report to medical any signs/symptoms of acute issues (seizures,
vomiting, dehydration, etc.)
1.
2.
3.
4.
5.

Librium 50mg po BID x 3 days then,
Librium 25mg po BID x 3 days then,
Librium 25mg po q HS x 3 days, then discontinue.
Thiamin 100mg po q AM x 10 days
MVI po q day x 14 days.

Clonidine 0.1mg po BID for BP > 140/90 for duration of detox.
Dilantin 300mg po q HS x 30 days
Re-evaluate need for antihypertensive or anticonvulsants at the end of the Detox period or within 48 hrs.
If patient is unable to take medications by mouth due to vomiting, provide electrolyte replacement and notify
provider.

BENZODIAZEPINE – VALIUM – DALMANE – XANAX DETOX
Please notify physician/provider before initiating protocol
Initiate Alcohol / Drug Withdrawal Flow Sheet Form.
Alert officers of status, and have them report to medical any signs/symptoms of acute issues (seizures,
vomiting, dehydration, etc.) Monitor intake and output, provide electrolyte replacement and contact
physician/provider.
1.
2.
3.
4.
5.

Librium 50mg po BID x 3 days then,
Librium 25mg po BID x 3 days then,
Librium 25mg po q HS x 3 days, then discontinue.
Thiamin 100mg po q AM x 10 days
MVI po q day x 14 days.

1-

Provider’s Initial/Date:

Treatment Protocols – Revised May 2014 – Revised November 2014- Confidential Work Product of SHP & Physician
Not to be a substitution for prudent medical judgment
Page | 10

SHP 000341

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•

I Southern Health

Partners

You r Partner In Affordable Inmate Healthcan

TREATMENT PROTOCOLS
Medical Department – County Jail

METHADONE/NARCOTIC DETOX
Please notify physician/provider prior to initiating protocol.
Initiate Alcohol / Drug Withdrawal Flow Sheet Form.
Alert officers of status, and have them report to medical any signs/symptoms of acute issues (seizures,
vomiting, dehydration, etc.). If patient is unable to take medications PO due to vomiting, begin electrolyte
replacement and notify provider for further instructions.
1.
2.
3.
4.

Vistaril 100mg PO BID x 4 days then,
Vistaril 75mg PO BID x 3 days then,
Vistaril 50mg PO BID x 3 days then,
Vistaril 25mg PO BID x 3 days, then discontinue.

If patient is experiencing aches/pains, nausea, and/or vomiting.
1. Ibuprofen 200-400mg every 8 hours as needed for aches/pain.
2. Phenergan 25mg PO/IM/PR every 4-6 hours as needed for nausea/vomiting
3. Monitor intake and output
4. Provide electrolyte replacement

Synthetic Cathinone (Bath Salts) Intoxication/Withdrawal:
Please notify physician/provider prior to initiating protocol
Initiate Alcohol / Drug Withdrawal Flow Sheet Form.
Alert officers of status, and have them report to medical any signs/symptoms of acute issues (seizures,
vomiting, etc.)
1.
2.
3.
4.

Vistaril 100mg PO BID x 4 days then,
Vistaril 75mg PO BID x 3 days then,
Vistaril 50mg PO BID x 3 days then,
Vistaril 25mg PO BID x 3 days, then discontinue.

For severe agitation, additional medicine may be necessary. Contact your physician/provider for further
orders. If seizures develop, transfer to ER.
Avoid beta blockers for tachycardia.
If BP reading with manual cuff is above 160/95, add Clonidine 0.1mg po bid and then check BP every 2
hours for 6 hours.
Monitor patient for food/fluids intake and output, monitor for dehydration. If patient is unable to take
medications PO due to vomiting, begin electrolyte replacement and notify provider for further instructions.
Provider’s Initial/Date:

Treatment Protocols – Revised May 2014 – Revised November 2014- Confidential Work Product of SHP & Physician
Not to be a substitution for prudent medical judgment
Page | 11

SHP 000342

Southern Health

I Partners

Your Partner In Affordable Inmate Healthcare

FLOW CHART FOR ALCOHOL/DRUG WITHDRAWAL
Document all findings once per shift (if shift is 12 hours – at least twice per shift). Report all findings to your
Medical Director. Medical Director must review and sign form at next Physician Sick Call. If patient experiences
changes or deterioration is noted, notify your Physician immediately for further orders.
Patient’s Name:

DOB:

ID #:

Inmate is being housed where (cell, medical, etc.):
Start Date of Monitoring:

Stop Date of Monitoring:

Date
Time
Weakness (Yes or No)
Restlessness (Yes or No)
Sweating (Yes or No)
Shakiness/Muscle Twitching
Anxiety (Reported)
Blood Pressure Reading
Pulse / O2 Sat Reading
Respiration Reading
Temperature Reading
Ataxia (Observed)
Drowsiness (Yes or No)
Vomiting (Reported/Observed)
Nausea (Reported)
Nystagmus
Confusion (Observed)
Slurred Speech (Observed)
Nurse Initials
Comments (time/date & initial)

Confidential Medical Information
Southern Health Partners, Inc., Form March 2013

SHP 000343

DEFINITION OF TERMS FOR FLOW CHART FOR ALCOHOL/DRUG WITHDRAWAL:
NOTE: While you should ask the patient of his/her symptoms, feelings, etc, document on the chart as to what you see with the patient.
Document vital signs at each visit also. Please alert correctional officers of the patient’s status if medical staff is not available on-site 24
hrs/day. Correctional officers should be advised as to signs or symptoms to look for regarding withdrawal.

Weakness - Lacking physical strength or vigor.
Restlessness - Inability to lie down, to cease from motion, constant activity of mind or body.
Sweating - Secretion of moisture through the skin pores. Colorless, salty, aqueous fluid, especially the glands of
the axillae, palms of hands, labia majora and anus.
Shakiness/Muscle Twitching - State of extreme irritability of muscle fibers causing loss of control of purposeful
movement.
Anxiety - A troubled feeling, experiencing a sense of dread or fear, distress over a real or imagined threat to one’s
mental or physical well-being.
Ataxia - Lack of order, especially in muscular coordination. Seen in alcoholics, caused by peripheral neuritis.
Drowsiness - A condition characterized by reduced physical activity, reduced vital signs, muscle relaxation, and
uncontrollable desire to sleep.
Vomiting - To eject stomach contents through the mouth.
Nausea - Inclination to vomit.
Nystagmus - Constant, involuntary, cyclical movement of eyeball. Movement may be in any direction.
Confusion - Lack of comprehension of reality, an emotional state of disorientation, not aware of time, place or
person.
Slurred speech - Slovenly articulation of words, letters and syllables are omitted.

Confidential Medical Information
Southern Health Partners, Inc., Form March 2013

SHP 000344

g
CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT OF ALCOHOL SCALE
Patient Name
Vital signs:

Date
BP

Pulse

Temp

NAUSEA AND VOMITING - As “Do you feel sick to your stomach? Have
you vomited?” Observation.
0 no nausea and no vomiting
1 mild nausea with no vomiting
2
3
4 intermittent nausea with dry heaves
5
6
7 constant nausea, frequent dry heaves and vomiting
TREMOR – Arms extended and fingers spread apart. Observation.
0 no tremor
1 not visible, but can be felt fingertip to fingertip
2
3
4 moderate, with patient’s arms extended
5
6
7 severe, even with arms not extended
PAROXYSMAL SWEATS – Observation.
0 no sweat visible
1 barely perceptible sweating, palms moist
2
3
4 beads of sweat obvious on forehead
5
6
7 drenching sweats
ANXIETY – Ask “Do you feel nervous?” Observation.
0 no anxiety, at ease
1 mildly anxious
2
3
4 moderately anxious, or guarded, so anxiety is inferred
5
6
7 equivalent to acute panic states as seen in severe delirium or acute
schizophrenic reactions
AGITATION – Observation.
0 normal activity
1 somewhat more than normal activity
2
3
4 moderately fidgety and restless
5
6
7 paces back and forth during most of the interview, or constantly thrashes
about

Patients scoring less than 10 do not usually need
additional medication for withdrawal. Review with your
Medical Director/Physician.

SHP Form 12/06

•

I Southern Health
Partners
You r Partner In Affordable Inmate Healt hca re

Time

Resp
TACTILE DISTURBANCES – Ask “Have you an itching, pins and needles
sensations, any burning, any numbness, or do you feel bugs crawling on or
under your skin?” Observation.
0 none
1 very mild itching, pins and needles burning or numbness
2 mild itching, pins and needles, burning or numbness
3 moderate itching, pins and needles, burning or numbness
4 moderately severe hallucinations
5 severe hallucinations
6 extremely severe hallucinations
7 continuous hallucinations
AUDITORY DISTURBANCES – Ask “Are you more aware of sounds
around you? Are they harsh? Do they frighten you? Are you hearing
anything that is disturbing to you? Are you hearing things you know are not
there?” Observation.
0 not present
1 very mild harshness or ability to frighten
2 mild harshness or ability to frighten
3 moderate harshness or ability to frighten
4 moderately severe hallucinations
5 severe hallucinations
6 extremely severe hallucinations
7 continuous hallucinations
VISUAL DISTURBANCES – Ask “Does the light appear to be too bright? Is
its color different? Does it hurt your eyes? Are you seeing anything that is
disturbing to you? Are you seeing things you know are not there?
Observation.
0 not present
1 very mild sensitivity
2 mild sensitivity
3 moderate sensitivity
4 moderately severe hallucinations
5 severe hallucinations
6 extremely severe hallucinations
7 continuous hallucinations
HEADACHE, FULLNESS IN HEAD – Ask “Does your head feel different?
Does it feel like there is a band around your head?” Do not rate for
dizziness or lightheadedness. Otherwise, rate severity.
0 not present
1 very mild
2 mild
3 moderate
4 moderately severe
5 severe
6 very severe
7 extremely severe
ORIENTATION AND CLOUDING OF SENSORIUM – Ask “What day is
this? Where are you? Who am I?
0 oriented and can do serial additions
1 cannot do serial additions or is uncertain about date
2 disoriented for date by no more than 2 calendar days
3 disoriented for date by more than 2 calendar days
4 disoriented for place/or person

Total CIWA Score
Rater’s Initials
Maximum Possible Score = 67

SHP 000345

 

 

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