By Asensio J.A., Trunkey D.D.
Evidence-based method of difficulties encountered in trauma and demanding care surgical events
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The principles of preventing and treating sedative-hypnotic withdrawal are similar to those used for alcohol. Management consists of substituting short-acting agents for longer-acting ones, and tapering the dose by 20% per day over 5 days. Cessation of stimulant use such as cocaine or methamphetamine is characterized by symptoms of depression and a substantial risk of suicidal behavior due to depressed cerebral dopamine levels. Patients with opiate dependence may experience ﬂu-like symptoms as the dose is tapered.
Committee on Injury Scaling: The Abbreviated Injury Scale 2005. Des Plains, IL, Association for the Advancement of Automotive Medicine, 2005. 10. Mackenzie EJ, Damiano A, Miller T: The development of the Functional Capacity Index. J Trauma 41:799–807, 1996. 11. Beverland DE, Rutherford WH: An assessment of the validity of injury severity score when applied to gunshot wounds. Injury 16:19–22, 1973. 12. Copes WS, Champion HR, Sacco WJ, et al: The injury severity score revisited. J Trauma 28:69–77, 1988.
7 Patients with a history of chronic alcohol use are more likely to have underlying medical conditions such as cardiomyopathy, liver disease, malnutrition, osteoporosis, and immunosuppression. Acute, in addition to chronic, alcohol use may also affect outcome from trauma. Alcohol causes respiratory depression as well as vasodilatation that limits the ability to compensate for major blood loss. 8 Acute alcohol intoxication has also been shown to be immunosuppressive. 6-fold increase in abdominal infectious complications, even after controlling for chronic use.