The overall goal for the prehospital care of patients with alcohol withdrawal is rapid transport to an appropriate facility while preventing injury to the patient or prehospital care provider. Recognition that alcohol withdrawal is an underlying medical disorder rather than a primary psychiatric disease is paramount. The presence of abnormal vital signs or severe agitation should prompt the prehospital care provider to transport the patient to a medical facility rather than a psychiatric facility. Agitation due to suspected alcohol withdrawal should be treated with benzodiazepines, when available, in the prehospital setting. Lorazepam, diazepam, or midazolam should all be effective. Midazolam is an ideal intramuscular option. There are no data regarding the prehospital administration of sedatives to patients with alcohol withdrawal. Antipsychotics should be avoided, as these may lower the seizure threshold.
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