Airway. Breathing. Circulation.

Originally published June 27, 2012
It’s been an exciting 8 days of trauma surgery, seeing so many things from knife wounds to two thoracotomies (one in the ED and the other in the OR) to classic textbook delirium tremens (DTs) with the alcohol withdrawal patient seeing spiders crawling on the ground as well as confusion and tremors. While I’ve had this unprecedented burst of energy throughout my 12+ hrs in the hospital, I feel a bit worn out today. There are many new paths to navigate in this strange place called hospital hierarchy, and I am doing my best to keep learning while trying to make sure I am completing the tasks expected of me. I know that bringing coffee to the attending or making sure that the charts are found and ready for the attending won’t help me do better on my shelf exam in 8 weeks, but I’m hoping that even such servitude will teach me discipline and to respect those with more years in medicine as I strive to learn from them what the books don’t (and can’t) say.

So now I have to study, after a long day of running around the hospital, a bit lost but bug eyed still. Wish me luck and be generous with the caffeine.

So surgery is one of the rare specialties that still gives beer to their alcoholic patients to prevent withdrawals (even at Loma Linda surprisingly) even though there’s no good evidence for its benefits outweighing its obvious negatives. Here’s an example of the 10-point alcohol withdrawal syndrome assessment scale (CIWA-Ar by Sullivan et al.) that you can use for a patient at risk for developing alcohol withdrawal and potentially save a life.