Emergency Dept Case StudiesEmergency Dept Case StudiesOverdose:Overdose:

A 20 yo female is brought by EMS after roommate called after patient stated she overdosed on unknown meds. Per EMT’s, patient was uncooperative on the scene, refusing to answer questions, would not allow prehospital personnel to evaluate her. Upon arrival to the ED patient appears lethargic, nonverbal, not following commands. What do you anticipate in the initial treatment of this patient?

•Assess patient for adequate airway; i.e. gag reflex, ability to handle secretions

•EKG and VS monitoring

•Sitter initiated

What is the significance of the EKG?

The EKG tracing can indicate prolonged QT interval, which can be associated with tricyclic overdose

What are the next priorities in this patient’s care?

•Obtain serum tox screen, chemistries and CBC. Place IV

The patient is more arouseable/co-operative and admits to taking handfuls of tylenol. What do you anticipate?

•Administration of mucomyst and charcoal either po or via ngt or IV. Ensure that lft’s have been sent, plus acetaminophen level. Obtain urine for toxic screen and ucg.

What other interventions are necessary in treating this patient?

Patient should be searched, valuables secured and sitter or security placed at the door. Psychiatry service should be consulted.