SGEM#440: I’m Gonna Need Someone To Help Me – GRACE4 AUD and CHS Management in the ED
May 25, 2024
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Dr. Bjug Borgundvaag discusses alcohol use disorder and cannabinoid hyperemesis syndrome management in the ED, emphasizing compassionate care, patient involvement in guidelines, evidence-based medicine, and effective management strategies including symptom-driven approaches, adjunctive medications, and novel therapies like capsaicin. The podcast highlights the importance of recognizing these conditions, utilizing evidence-based treatments, and navigating limited evidence in emergency medicine.
Providers should focus on recognizing and assisting individuals with alcohol use disorder in the ED.
Prescription of anti-craving medications for alcohol use disorder is underutilized despite being safe and effective.
Challenges in managing cannabinoid hyperemesis syndrome call for further research to improve treatment options.
Deep dives
Alcohol Use Disorder: Recognition in the Emergency Department
Alcohol use disorder is a prevalent issue impacting emergency departments significantly. Emergency care providers play a crucial role in recognizing and offering help to individuals with alcohol-related problems. The lack of education on managing alcohol-related conditions emphasizes the need for improved training in medical education. Despite the availability of safe and effective anti-craving medications, they are underprescribed, highlighting a growth opportunity in this area. The urgent need for additional evidence is essential to further enhance patient care and address the stigma around substance use disorders.
Anti-Craving Medications and Alcohol Use Disorder
Despite the long-standing availability and proven safety and effectiveness of anti-craving medications, they are prescribed to less than 1% of patients with alcohol use disorder. Encouraging the regular use of these treatments based on the existing evidence, even with low certainty, can significantly impact patient outcomes. The importance of approaching patients with addiction in a non-judgmental and compassionate manner to foster therapeutic relationships underscores the potential for positive outcomes.
Challenges of Cannabis Hyperemesis Syndrome
Cannabis hyperemesis syndrome poses a challenge in patient management due to the lack of effective treatment options and patients' reluctance to attribute symptoms to cannabis use. While the evidence for dopamine antagonists and capsaicin is limited, their anecdotal effectiveness is growing. The urgency for further research is stressed to establish high-quality evidence to guide better management strategies for this condition.
Limited Evidence and Treatment Approaches
Despite the limited evidence in various treatment areas, the current evidence supports the use of available treatments even with a low level of certainty. The emphasis on trying interventions based on the existing evidence instead of waiting for high-quality data resonates the importance of providing timely and effective care to patients. The positive message conveyed is that emergency care providers can offer tangible help to individuals with addiction-related issues.
Engagement and Support for Patients
Encouraging honest conversations and compassionate engagement with patients experiencing substance use disorders can lead to better therapeutic outcomes and reduce stigma. Laying emphasis on the need for additional research and evidence in these areas while highlighting the opportunity for clinicians to positively impact patient care underscores the vital role emergency care providers play in improving patient outcomes.
Remembering to Empower Emergency Care Providers
Empowering emergency care providers to recognize and offer effective help to patients with substance use disorders is a critical aspect of patient care. The importance of utilizing available evidence, educating clinicians, and fostering a non-judgmental approach in patient interactions can significantly improve treatment outcomes and reduce the stigma surrounding substance use disorders. Encouraging proactive patient engagement and delivering timely care aligns with the goal of enhancing patient care in emergency departments.
Reference: Borgundvaag et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. AEM May 2024 Date: May 22, 2024 Guest Skeptic: Dr. Bjug Borgundvaag is the Founding Director of the Schwartz/Reisman Emergency Medicine Institute (SREMI), at Sinai Health System. He […]