Toxicology - Case 1

Toxicology Case 1

Module Author: Kevin Baumlin, MD
Web Author: Michael Bessette, MD

Situation

Notification is received by your nurse and you are informed that EMS will be bringing in 46 year old female who is unconscious, intubated with a pulse, but no palpable BP.

1. What equipment do you prepare pending the arrival of this patient?

EMS arrives and informs you that the patient took an overdose of pills and hand you an empty bottle of Doxepin and a half empty bottle of Buspar. The patient is intubated being bagged, BP is 60/palp, HR 123, she is unresponsive to painful stimuli.

2. What do you do? Comment on what labs you would obtain as well.

After being placed on a monitor, you notice a wide complex tachycardia and request an EKG.

3.

4. Considering the patients EKG and history what is your next step?

5. What medication would be best for treatment of this patients hypotension, and why?

EMS has no idea what time the patient ingested the pills. A suicide note was not at the scene, but you have obtained no further information from any family member.

6. What about gastric lavage and charcoal?

While you are lavaging the patient she begins myoclonic jerking.

7. What do you use to treat this?

She stops shaking and has become a bit edematous from your fluid resuscitation. You decide to recheck the EKG and ABG.
The ABG is 7.59/27/68/96%

8.

The patient is finally transferred to the MICU.

Follow-up:

You decide to go up to the unit to see how she is doing a few days later. You go to her bedside and introduce yourself as the physician who cared for her in the ED, of course expecting one of those tingly moments where a patient expresses deep gratitude for your fine effort to save their life. She sits up, looks you in the eye and asks, "Can you get me a pill for my nerves?"

True Story!

		1.	What equipment do you prepare pending the arrival of this patient?

		EMS arrives and informs you that the patient took an overdose of pills and hand you an empty bottle of Doxepin and a half empty bottle of Buspar. The patient is intubated being bagged, BP is 60/palp, HR 123, she is unresponsive to painful stimuli.
		2.	What do you do? Comment on what labs you would obtain as well.

		After being placed on a monitor, you notice a wide complex tachycardia and request an EKG.
		3.

		4.	Considering the patients EKG and history what is your next step?

		5.	What medication would be best for treatment of this patients hypotension, and why?

		EMS has no idea what time the patient ingested the pills. A suicide note was not at the scene, but you have obtained no further information from any family member.
		6.	What about gastric lavage and charcoal?

		While you are lavaging the patient she begins myoclonic jerking.
		7.	What do you use to treat this?

		She stops shaking and has become a bit edematous from your fluid resuscitation. You decide to recheck the EKG and ABG. The ABG is 7.59/27/68/96%
		8.

		The patient is finally transferred to the MICU.