This case was written by Dr. Brad Stebner. Brad is a PGY3 Emergency Medicine resident at the University of British Columbia. His interests include medical education and leadership, sports medicine, and health care administration. He is particularly interested in using simulation to evaluate system efficiency, crisis resource management, and interprofessional collaboration. He completed his BSc at Michigan Tech University while playing NCAA hockey and his MD at the University of Calgary.
WHY IT MATTERS
The opioid epidemic continues to sweep North America causing untold morbidity and mortality. In addition, violence in the ED is an increasingly important topic that requires preparation ahead of incidents in order to ensure a safe outcome for all involved. This case gives a chance to practice management of an overdose patient as well as to develop and/or refine ED protocols for dealing with an armed patient including handling of a weapon.
EMS notes state this patient was found downtown unresponsive. He was given one dose of 0.4mg IM naloxone and brought into the ED. Cap glucose 5.2 mmol/L. NRB at 15L/min applied. They also found a pool of blood around the patient and placed some gauze onto a bleeding scalp laceration.
In this case a 44 y/o M is brought in via EMS after receiving 0.4mg of naloxone for what is suspected to be an opioid overdose. He remains GCS 7 upon arrival in the resuscitation bay. The team will need to work through the differential for altered LoC and will find drug paraphernalia and a loaded weapon on the patient upon inspection. The case will end with successful treatment and consultation with local police with regard to weapon and contraband protocols.