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CE ARTICLE cubital area. The patient receives 2 mg of Ativan for his agitation and 4 mg of ondan- setron for his nausea. He gets another 2 mg of Ativan IV 10 minutes later when he's noted to still be agitated. He remains agitated but otherwise has an uneventful transport to the emergency department. At the ED the patient continues to be agitated and is restrained in soft four- point restraints. While being restrained he suffers a brief seizure and is given addi- tional Ativan. Although the seizure activity is halted, the patient continues to be tremu- lous and tachycardic. He is placed on an Ativan drip and admitted to the ICU. Over the next four days the Ativan drip is down- titrated, and the patient is ultimately tran- sitioned to PO benzodiazepines. After fve days he is discharged to a rehab facility. REFERENCES 1. National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5, http://pubs.niaaa.nih.gov/publications/ dsmfactsheet/dsmfact.htm. 2. Gold MS, Aronson MD. Alcohol use disorder: epidemiology, pathogenesis, clinical manifestations, adverse consequences, and diagnosis. UpToDate, www.uptodate.com/contents/alcohol-use-disorder- epidemiology-pathogenesis-clinical-manifestations- adverse-consequences-and-diagnosis. 3. Morse RM, Flavin DK. The defnition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to study the defnition and criteria for the diagnosis of alcoholism. JAMA, 1992 Aug 26; 268(8): 1,012–4. 4. Bernstein E, Bernstein JA, Fernandez W, D'Onofrio G. Chapter 289: Alcohol and Other Drugs of Abuse. In: Tintinalli JE, et al., Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7th ed. New York: McGraw- Hill, 2011. 5. Offce of National Drug Control Policy. Substance Abuse and the Affordable Care Act, www.whitehouse.gov/ondcp/ healthcare. 6. U.S. Department of Health & Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician's Guide, http://pubs.niaaa.nih.gov/publications/ Practitioner/CliniciansGuide2005/guide.pdf. 7. Saitz R, O'Malley SS. Pharmacotherapies for alcohol abuse. Withdrawal and treatment. Med Clin North Am, 1997 Jul; 81(4): 881–907. 8. Isbell H, Frasher HF, Wilker A, Belleville RE, Eisenman AJ. An experimental study of the etiology of rum fts and delirium tremens. Q J Stud Alcohol, 1955 Mar; 16(1): 1–33. 9. Finnell JT. Chapter 185: Alcohol-related Disease. In: Marx J, Hockberger R, Walls R, Rosen's Emergency Medicine, 8th ed. Mosby, 2013. 10. Hoffman RS, Weinhouse GL. Management of moderate and severe alcohol withdrawal syndromes. UpToDate, www.uptodate.com/contents/management-of-moderate- and-severe-alcohol-withdrawal-syndromes. 11. Charness ME. So YT. Wernicke's encephalopathy. UpToDate, www.uptodate.com/contents/wernickes- encephalopathy. 12. Harper CG, Giles M, Finlay-Jones R. Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry, 1986 Apr; 49(4): 341–5. 13. Victor M, Brausch C. The role of abstinence in the genesis of alcoholic epilepsy. Epilepsia, 1967 Mar; 8(1): 1–20. Scott R. Snyder, BS, NREMT-P, is a faculty member at the Public Safety Training Center in the Emergency Care Program at Santa Rosa Junior College, CA. E-mail scottrsnyder@me.com. Sean M. Kivlehan, MD, MPH, NREMT-P, is an emergency medicine resident at the University of California, San Francisco. E-mail sean.kivlehan@ gmail.com. Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT, is performance improvement coordinator for Airlink/Vitalink in Wilmington, NC, and a lead instructor for Wilderness Medical Associates. E-mail kcollopy@colgatealumni.org. 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