EM Cases · Alcohol and benzodiazepine withdrawal
Delirium tremens — the agitated alcoholic resus station
ACEM Fellowship resus station testing CIWA-Ar-guided benzodiazepine loading, thiamine-before-glucose, mimic exclusion, and HDU/ICU escalation for delirium tremens.
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Study tools
Target exams
ACEMFRCEMABEMFRCPCCCFPEMEBEEM
Prompt
A middle-aged man with known heavy alcohol use becomes agitated, febrile and tachycardic 60 hours after last drink, with fluctuating consciousness and visual hallucinations.
Stem
All persons, presentations and observations in this station are fictional and invented for teaching assessment; they do not describe a real person.
Format. Clinical-management (resus) station, 11 minutes total — 4 minutes reading, 7 minutes active assessment. You are the Emergency Medicine consultant leading the resuscitation.
Candidate instructions. Manage the patient. State actions and reasoning aloud. The examiner plays nursing and laboratory staff.[3]
References5ShowHide
- [1]Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). British Journal of Addiction, 1989.PMID 2597811
- [2]Mayo-Smith MF Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based guideline. JAMA, 1997.PMID 9214531
- [3]Kattimani S, Bharadwaj B Clinical management of alcohol withdrawal: A systematic review. Industrial psychiatry journal, 2013.PMID 25013309
- [5]Jasti J, Sherman K, Gummin D, et al. Prevalence of Wernicke's Encephalopathy When Receiving Dextrose Before Thiamine: A National Study of Veterans. Academic Emergency Medicine, 2025.PMID 40873301
- [4]Veiraiah A, Dyas J, Cooper G, Routledge PA, Thompson JP. Flumazenil use in benzodiazepine overdose in the UK: a retrospective survey of NPIS data. Emergency Medicine Journal, 2012.PMID 21785147