This is the eleventh case in a series we are publishing that make up “The Nightmares Course” – a Sim Bootcamp for new residents. It’s 23:00 and you’re called to assess a 42-year old man who is difficult to rouse on evening rounds.
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.
Beta Blocker Toxicity
A 44-year-old male presents to the emergency department following the ingestion of an entire bottle of metoprolol. Decontamination strategies should be utilized alongside consultation with poison control. Patient clinically deteriorates as the drug reaches peak effects, requiring IV fluids, atropine, calcium, glucagon, multi-dose vasopressors, high dose insulin, and a discussion around potential salvage therapies.
A 48-year-old female presents with a possible multi-drug overdose including glyburide, clonazepam and nifedipine. She will remain hypotensive throughout the case, despite treatment with calcium, high dose insulin, and other vasopressors. She will also have progressive respiratory depression and will eventually require intubation. She will then proceed to arrest. The team will be expected to give intralipid once the patient has arrested.
This case is written by Dr. Kyla Caners. She is a PGY5 Emergency Medicine resident at McMaster University and is also one of the Editors-in-Chief here at EMSimCases. Why it Matters Digoxin toxicity is of critical importance to recognize. There are many subtleties to its management, which means that the concepts of digoxin toxicity are important … Continue reading Digoxin Overdose
22 year-old female presents saying she just ingested 60 tablets of ASA because she wants to die. Her mom found her while she was finishing the bottle of 325mg tabs approximately 60 minutes ago and called EMS. The patient is complaining of nausea and tinnitus and is tachypneic. The team should consider activated charcoal and alkalinize the urine. If they do not initiate treatments, they will receive a critical VBG showing a mixed respiratory alkalosis and metabolic acidosis. The patient will then become somnolent. The team will be expected to check her blood sugar and call for dialysis. They will also need to intubate and recognize the need to hyperventilate and dialyze.
Opioid Overdose with ARDS
A 34-year-old male was found unconscious in an alleyway by bystanders who called EMS. The patient presents with a clinical opioid intoxication requiring naloxone administration. The patient also presents with acute respiratory distress syndrome (ARDS) secondary to heroin use requiring airway support, intubation and mechanical ventilation.