SimFridays - Alcohol withdrawal seizure

For January we’ll look at patients with mental health or substance-related presentations. In this sim a man with alcohol withdrawal presented following a presumed seizure. We'll repeat this sim next week.

The simulated case: 
A man in his 40s brought into ED after a presumed unwitnessed seizure having cut down on alcohol during COVID19 lockdown. He moved through START into majors but following another seizure he moved into resus. This self-terminated. 

What happened?
Joint nurse and doctor assessment to establish history and examine the patient. Blood tests, Pabrinex and withdrawal treatment were started. It was decided that the patient needed to be admitted given that he had multiple seizures. 

What did we think? 
In debrief we discussed:

Role of vitamin replacement:
This patient received IV Pabrinex. In alcohol misuse thiamine (vitamin B1) deficiency is more likely, and Pabrinex is used to rapidly replace this vitamin in order to prevent or treat Wernicke’s encephalopathy. Without treatment Wernicke’s can be life-threatening. 

We talked about the same people may well have nutritional deficiencies that mean they are at risk of refeeding syndrome whilst in hospital.

Alcohol liaison:
Alcohol liaison specialists are available 08:30-17:00 Monday to Friday. You can find the number in the ‘daily email’ 30/11/20, and I have also added them to the Induction app under “alcohol liaison”. 

Remember not to presume they are already in contact with services, or presume based on previous presentations that they don’t want to be. The relevant organisations for us are:
Plymouth patients - Harbour
Cornwall patients - Addaction
Devon patients - RISE recovery

Raising the alarm:
During COVID19 we’ve welcomed many new members of staff to the emergency department. We talked about differences between ED and areas of the hospital that staff have previously worked in, in terms of reasons to pull emergency buzzers. A seizure is a perfectly good reason to pull an emergency buzzer, as is any scenario where you need a greater number of people to be present immediately. 


To do:
If you see a patient like this in-hours, speak to the alcohol liaison team and find out what additional help can be put in place for them  [  ]

If you took part in the sim, you can use this blog as a starter to reflect on your own experience of it   [  ]

Blog by: James Keitley ED sim fellow

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