第四学术急诊医学学会（SAEM）急诊科合理和适当护理指南（GRACE-4）是关于急诊科（ED）管理非阿片类药物使用障碍的主题，重点是酒精戒断综合征（AWS）。酒精使用障碍（AUD），和大麻素剧吐综合征（CHS）。SAEMGRACE-4写作团队，由急诊医生和成瘾医学专家以及有生活经验的患者组成，应用了建议评估开发和评估（GRADE）方法，以评估有关AWS成年ED患者的六个优先问题的证据的确定性和建议的强度，AUD,和CHS。SAEMGRACE-4写作团队达成了以下建议：（1）对于住院的中度至重度AWS的成年ED患者（18岁以上），我们建议使用苯巴比妥与苯二氮卓类药物相比单独使用苯二氮卓类药物[证据的确定性低至非常低];(2)在需要戒酒的成人ED患者(18岁以上)中,我们建议处方一种抗药物[证据的确定性非常低];（2a）在成人ED患者（18岁以上）与AUD，我们建议纳曲酮（与无处方相比）以防止再次大量饮酒[证据确定性低]；（2b）在成年ED患者（18岁以上）中，有AUD和纳曲酮禁忌症，我们建议阿坎酸（与无处方相比），以防止再次大量饮酒和/或减少大量饮酒[证据的低确定性];（2c）在AUD的成年ED患者（18岁以上）中，我们建议加巴喷丁（与无处方相比）用于AUD的管理，以减少大量饮酒天数并改善酒精戒断症状[证据的确定性非常低]；（3a）在出现CHS的ED的成年ED患者（18岁以上）中，我们建议使用氟哌啶醇或氟哌啶醇（除常规护理/5-羟色胺拮抗剂外，例如，昂丹司琼），以帮助症状管理[证据的确定性非常低]；和（3b）在成年ED患者（18岁以上）出现CHS的ED，我们还建议使用局部辣椒素（除了常规护理/5-羟色胺拮抗剂，例如，昂丹司琼）帮助症状管理[证据确定性非常低]。
The fourth Society for Academic Emergency Medicine (SAEM)
Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4) is on the topic of the emergency department (ED) management of nonopioid use disorders and focuses on alcohol withdrawal syndrome (AWS), alcohol use disorder (AUD), and cannabinoid hyperemesis syndrome (CHS). The SAEM GRACE-4 Writing Team, composed of emergency physicians and experts in addiction medicine and patients with lived experience, applied the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding six priority questions for adult ED patients with AWS, AUD, and CHS. The SAEM GRACE-4 Writing Team reached the following recommendations: (1) in adult ED patients (over the age of 18) with moderate to severe AWS who are being admitted to hospital, we suggest using phenobarbital in addition to benzodiazepines compared to using benzodiazepines alone [low to very low certainty of evidence]; (2) in adult ED patients (over the age of 18) with AUD who desire alcohol cessation, we suggest a prescription for one anticraving medication [very low certainty of evidence]; (2a) in adult ED patients (over the age of 18) with AUD, we suggest naltrexone (compared to no prescription) to prevent return to heavy drinking [low certainty of evidence]; (2b) in adult ED patients (over the age of 18) with AUD and contraindications to naltrexone, we suggest acamprosate (compared to no prescription) to prevent return to heavy drinking and/or to reduce heavy drinking [low certainty of evidence]; (2c) in adult ED patients (over the age of 18) with AUD, we suggest gabapentin (compared to no prescription) for the management of AUD to reduce heavy drinking days and improve alcohol withdrawal symptoms [very low certainty of evidence]; (3a) in adult ED patients (over the age of 18) presenting to the ED with CHS we suggest the use of haloperidol or droperidol (in addition to usual care/serotonin antagonists, e.g., ondansetron) to help with symptom management [very low certainty of evidence]; and (3b) in adult ED patients (over the age of 18) presenting to the ED with CHS, we also suggest offering the use of topical capsaicin (in addition to usual care/serotonin antagonists, e.g., ondansetron) to help with symptom management [very low certainty of evidence].
