Snapshot A 56-year-old man is brought to the ED after he had a severe episode of hematemesis. On exam, you note spider angiomas, and abdominal ascites. His hand is show at right. Introduction Definition is clinical login to view 5 more bullets Presentation Symptoms login to view 8 more bullets Physical exam login to view 17 more bullets Evaluation CAGE test login to view 2 more bullets Serology login to view 4 more bullets Treatment Pharmacologic login to view 8 more bullets Psychotherapy login to view 3 more bullets Prognosis, Prevention, Complications Complications login to view 9 more bullets ED ManagementInpatient ManagementChronic ManagementPrevent further ethanol intakePrevent individual from harming self or othersSedate patient if agitated or aggressiveOrder urine toxicity screenStabilize vitals if necessaryAdminister (in order)thiamine and Mg2+multivitaminB12/folateIV fluids + dextroseBegin CIWA and benzodiazepine taper if signs of withdrawalDo not administer medications that lower seizure threshhold (bupropion, haloperidol)Begin psychotherapy (must occur with medications)individualgroup (AAA)Begin medication immediatelydisulfiramnaltrexoneacamprosategabapentintopiramate