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Free Open Access Short Answer Questions for ED Fellowship Study

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Case: Undifferentiated overdose

You are the consultant on shift in a rural emergency department. A 42-year-old man is brought in by ambulance service after a presumed overdose. It is unknown what he has taken. He was last seen well yesterday and was found drowsy at home with a suicide note after friends struggled to contact him. His friend reported that he has a history of mental health problems, epilepsy and diabetes. GCS 9 HR 118 BP 96/40 RR 20 SpO2 97% on 2LNP T 36.4

1. List four possible agents which the patient may have overdosed on to give this clinical presentation. Each example should be from a different class of medication. 4 marks

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2. Give two specific ECG findings you would look for with a relevant medication for each. 2 marks

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Neither your examination nor the ECG help confirm or rule out any specific agent. His BSL is 4.6, however the patient appears to be deteriorating with increasing sedation.

3. Give two ways you could get further information about what medication the patient had access to and possibly took. 2 marks

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Unfortunately, the patient begins vomiting so you emergency intubate him. There are some tablet fragments in the vomitus. GCS 3, HR 126, BP 84/42, RR 16, SpO2 98% on FiO2 0.5, T 36.1

4. Outline your priorities for ongoing management of the patient. 4 marks

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