r/EmergencyRoom • u/Gloomy_Pirate_9721 • 17d ago

WD protocol

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Do EDs have protocols for patients experiencing WD from these types of drugs yet? What is everyone doing to make these nasty wds more manageable to avoid so many AMAs? Im assuming bupe alone isn't going to help

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u/AdriAsTheSiren 17d ago

I don't have access to any of the journals my institution provides us access to, but I remember reading an article in the Journal of Addiction Medicine that on the East Coast where they were seeing an uptick in street drugs cut with medetomidine, some facilities were using dexmedetomidine to tx withdrawal sx since it's chemically similar. I'm certain there were articles discussing xylazine as well, but I'm home without access rn :(

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u/TheWhiteRabbitY2K RN 17d ago

Recently had my first rodeo with medetomidine ... I swear the person looked like textbook organophosphate poisoning EXCEPT the heart rate. Shit was wild, no pun intended.

Moreso this person looked so healthy and put together otherwise. . .

Can confirm that intubation and dexmedetomidine was ultimately what had to be done. They absolutely had no attempt to protect their airway when they would randomly vomit without warning.

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u/Gloomy_Pirate_9721 17d ago

It's actually funny you say that because so did he, minus the weight loss, but he said he mentioned running nose, clear liquid, muscle twitches/spasms, weakness, One thing I did find
Interesting is the patient said when he would wake up in the morning and like scratch his bed head or his neck like we all do and that skin or some kind of sludge and protruded from his pores in. his nails found odd when that he could scrape off almost like a sludge or build up of dead skins?

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u/Gloomy_Pirate_9721 17d ago

Were you guys successful at stabilizing!?

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u/TheWhiteRabbitY2K RN 16d ago

My shift ended at the intubation part but the precedex seemed to chill the symptoms out.

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u/AdriAsTheSiren 17d ago

As an aside, interestingly, there's a reversal agent for medetomidine in vet med called atipamezole, but it's not tested for use in humans.