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.
Local Anesthetic Systemic Toxicity
A femoral nerve block has just been performed on a 65-year-old male who sustained a right femoral neck fracture. The patient also sustained a laceration to the scalp which was repaired by the medical student. The patient is now complaining of blurry vision, paresthesias, and “twitchiness”. The patient progresses on to seizure followed by cardiac arrest and will need high quality ACLS care along with lipid emulsion therapy.
Toxic Alcohol Ingestion
A 46 year-old male presents with a GCS of 3 after being found in the back alley behind a drug store. The team will need to work through a broad differential diagnosis and recognize the need to intubate the patient. If they try naloxone, it will have no effect. After intubation, the team will receive critical VBG results showing a profound metabolic acidosis with a significant anion gap. The goal is to trigger the team to work through the possible causes of an elevated anion gap, including toxic alcohols.
Tricyclic Antidepressant Overdose
A 27-year-old male presents to the emergency department with altered mental status after an intentional Amitriptyline overdose. He is found to have a wide QRS complex and an anticholinergic toxidrome. The patient deteriorates into PEA arrest necessitating advanced cardiac life support (ACLS) and intravenous sodium bicarbonate therapy.