The Trauma Profssional Blog - June 13, 2016 - By Michael McGonigal
"What exactly is the CIWA protocol?The Clinical Institute Withdrawal Assessment measures 10 items that are associated with withdrawal:
- Nausea / vomiting
- Anxiety
- Paroxysmal sweats
- Tactile disturbances (itching, bugs crawling on skin, etc)
- Visual disturbances
- Tremors
- Agitation
- Orientation
- Auditory disturbances
- Headache
The total score is used to determine whether benzodiazepines should be given to ameliorate symptoms or avoid seizures. Typically, a threshold is selected (8 or 10) and no medications are needed as long as the patient is under it. Once it is exceeded, graduated doses of lorazepam or diazepam are given and vital signs and CIWA scores are repeated regularly. The protocol is discontinued once the patient has three determinations that are under the threshold.
The individual dosing scale and monitoring routine varies by hospital. Look at your hospital policy manual to get specifics for your institution."