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In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2025 Emergency Medicine Practice article, Diagnosis and Management of Emergency Department Patients With Alcohol Withdrawal Syndrome
- Epidemiology & Background
- Rising ED visits related to alcohol use.
- Mortality rates and spectrum of patient presentations.
- Importance of high suspicion and complexity of cases.
- Pathophysiology & Mechanisms
- Alcohol metabolism and neurochemical changes.
- Differential diagnosis: Conditions that mimic alcohol withdrawal.
- Prehospital & EMS Considerations
- Role of EMS in triage and initial management.
- Use of sobering centers vs. ED transport.
- Prehospital administration of benzodiazepines (IM midazolam).
- History & Risk Assessment
- Key questions to assess risk for alcohol withdrawal syndrome.
- Importance of patient history, medication use, and comorbidities.
- Discussion on patient honesty and rapport.
- Physical Exam & Scoring Systems
- DSM-5 criteria for alcohol withdrawal.
- Use of CIWA-AR, BAWS, and PAWSS scoring systems.
- Importance of objective measurement for monitoring and disposition.
- Complications & Special Presentations
- Complicated alcohol withdrawal: Hallucinosis, seizures, delirium tremens.
- Diagnostic workup: Labs, imaging, and co-ingestions.
- Special populations: End-stage liver disease, pregnancy, intubated patients.
- Treatment Strategies
- Mainstay: Benzodiazepines (types, dosing, and protocols).
- Phenobarbital: Indications, dosing, and evidence.
- Adjunctive therapies: Thiamine, glucose, magnesium.
- Alternative/adjunct medications: Gabapentin, ketamine, dexmedetomidine, baclofen.
- Clinical Pearls & Practice Changes
- Early, aggressive therapy to prevent complications.
- Symptom-based vs. fixed-schedule treatment.
- Gabapentin as an alternative or adjunct.
- Anti-craving medications for relapse prevention.
- Disposition & Protocols
- Use of scoring systems for safe discharge, observation, or admission.
- Importance of protocolized approaches and community resources.
- Summary & Take-Home Points
- Five key practice-changing points.
- Clinical pathway.
Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2025 Emergency Medicine Practice article, Diagnosis and Management of Emergency Department Patients With Alcohol Withdrawal Syndrome
- Epidemiology & Background
- Rising ED visits related to alcohol use.
- Mortality rates and spectrum of patient presentations.
- Importance of high suspicion and complexity of cases.
- Pathophysiology & Mechanisms
- Alcohol metabolism and neurochemical changes.
- Differential diagnosis: Conditions that mimic alcohol withdrawal.
- Prehospital & EMS Considerations
- Role of EMS in triage and initial management.
- Use of sobering centers vs. ED transport.
- Prehospital administration of benzodiazepines (IM midazolam).
- History & Risk Assessment
- Key questions to assess risk for alcohol withdrawal syndrome.
- Importance of patient history, medication use, and comorbidities.
- Discussion on patient honesty and rapport.
- Physical Exam & Scoring Systems
- DSM-5 criteria for alcohol withdrawal.
- Use of CIWA-AR, BAWS, and PAWSS scoring systems.
- Importance of objective measurement for monitoring and disposition.
- Complications & Special Presentations
- Complicated alcohol withdrawal: Hallucinosis, seizures, delirium tremens.
- Diagnostic workup: Labs, imaging, and co-ingestions.
- Special populations: End-stage liver disease, pregnancy, intubated patients.
- Treatment Strategies
- Mainstay: Benzodiazepines (types, dosing, and protocols).
- Phenobarbital: Indications, dosing, and evidence.
- Adjunctive therapies: Thiamine, glucose, magnesium.
- Alternative/adjunct medications: Gabapentin, ketamine, dexmedetomidine, baclofen.
- Clinical Pearls & Practice Changes
- Early, aggressive therapy to prevent complications.
- Symptom-based vs. fixed-schedule treatment.
- Gabapentin as an alternative or adjunct.
- Anti-craving medications for relapse prevention.
- Disposition & Protocols
- Use of scoring systems for safe discharge, observation, or admission.
- Importance of protocolized approaches and community resources.
- Summary & Take-Home Points
- Five key practice-changing points.
- Clinical pathway.
Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
