Addiction Medicine Certification Emergency Procedures & Response 3 — Questions and Answers
Question 1: A patient receiving inpatient alcohol detoxification develops sudden-onset confusion, fever, tachycardia, and profuse sweating on day 3. Which condition must be ruled out first?
- Wernicke's encephalopathy
- Delirium tremens (Correct answer)
- Hepatic encephalopathy
- Sepsis from aspiration pneumonia
Correct answer: Delirium tremens
Delirium tremens typically peaks at 48–96 hours after last drink and presents with autonomic instability, fever, and delirium, carrying up to 5% mortality if untreated.
Question 2: An adolescent is brought to the ED after ingesting an unknown quantity of prescription opioids. Parents report the teen also uses marijuana regularly. Which assessment tool is most appropriate for immediate triage of overdose severity?
- CRAFFT Screen
- Glasgow Coma Scale and respiratory rate assessment (Correct answer)
- AUDIT-C questionnaire
- CAGE questionnaire
Correct answer: Glasgow Coma Scale and respiratory rate assessment
GCS and respiratory rate provide the most immediate objective data for assessing opioid overdose severity and guiding naloxone administration in an emergency setting.
Question 3: A patient with alcohol use disorder develops sudden severe ataxia, ophthalmoplegia, and confusion in the ED. What should be administered IMMEDIATELY?
- Oral thiamine 100 mg with a meal
- IV thiamine 500 mg before any glucose administration (Correct answer)
- Glucose bolus followed by oral vitamins
- Folic acid 1 mg IV
Correct answer: IV thiamine 500 mg before any glucose administration
This triad is Wernicke's encephalopathy; high-dose IV thiamine must precede glucose to avoid precipitating or worsening thiamine-dependent metabolic failure.
Question 4: During opioid overdose resuscitation, the patient regains consciousness after naloxone but becomes combative and tries to leave against medical advice. What is the most important clinical consideration?
- Naloxone reversal is complete and the patient may safely leave
- Naloxone's duration of action (30–90 min) is shorter than most opioids, requiring observation for re-narcotization (Correct answer)
- Administer a second naloxone dose to prevent re-sedation
- Discharge with a prescription for naloxone only
Correct answer: Naloxone's duration of action (30–90 min) is shorter than most opioids, requiring observation for re-narcotization
Naloxone's half-life is shorter than most opioids, so re-narcotization can occur after the patient appears awake, necessitating monitored observation for at least 4 hours.
Question 5: A patient on high-dose prescribed opioids for chronic pain develops iatrogenic respiratory depression in a clinic. Naloxone is given but the patient goes into acute opioid withdrawal with severe pain. What is the safest approach?
- Administer full reversal dose of 2 mg naloxone
- Titrate low-dose naloxone (0.04 mg increments) to restore respirations without full reversal (Correct answer)
- Stop naloxone and allow the patient to self-limit
- Administer methadone to counteract withdrawal
Correct answer: Titrate low-dose naloxone (0.04 mg increments) to restore respirations without full reversal
Low-dose titrated naloxone (0.04 mg increments) restores adequate ventilation while minimizing acute withdrawal and pain crisis in opioid-dependent patients.
Question 6: Which finding during opioid withdrawal management most urgently requires emergency medical evaluation beyond standard detox protocols?
- Rhinorrhea and lacrimation
- Piloerection and yawning
- Chest pain, severe hypertension (200/120 mmHg), and altered mental status (Correct answer)
- Mild diarrhea and insomnia
Correct answer: Chest pain, severe hypertension (200/120 mmHg), and altered mental status
Hypertensive crisis with chest pain and altered mentation during withdrawal exceeds expected opioid withdrawal and may indicate a co-occurring emergency requiring immediate medical evaluation.
Question 7: A patient presents in sedative-hypnotic withdrawal with a CIWA-B score of 20. Which setting is MOST appropriate for management?
- Outpatient weekly follow-up
- Ambulatory detox with daily check-ins
- Inpatient medically supervised detoxification (Correct answer)
- Home taper with phone support only
Correct answer: Inpatient medically supervised detoxification
A high CIWA-B score indicates severe benzodiazepine or sedative withdrawal, which carries seizure and death risk comparable to alcohol withdrawal, requiring inpatient medical supervision.
Addiction Medicine Certification Emergency Procedures & Response 3
A patient receiving inpatient alcohol detoxification develops sudden-onset confusion, fever, tachycardia, and profuse sweating on day 3.
Which condition must be ruled out first?