the case.
87 year old female presents to your ED following an intentional overdose. She tells you that approximately 4 hours ago she ingested ‘most of [her] digoxin tablets’ that she bought earlier in the afternoon. [Read more…]
pulling apart cases from the ED...
the case.
87 year old female presents to your ED following an intentional overdose. She tells you that approximately 4 hours ago she ingested ‘most of [her] digoxin tablets’ that she bought earlier in the afternoon. [Read more…]
the case.
A 48 year old female arrives to ED via ambulance following an intentional overdose. Her husband discovered her taking tablet after tablet in the bathroom at home. She has a history of depression & diabetes and reports feeling ‘a little low’…
As the paramedics finish handover, they hand you these…. [Read more…]
The case.
64 year old female who is day 1 post elective left total-knee replacement. She has a past medical history of osteoarthritis, bipolar disorder and depression for which she takes quetiapine, lithium and paracetamol. You are asked to see her on the ward for optimization of her pain management with a concern that she “just isn’t quite right” with confusion & new onset of word finding difficulties.
the case.
23 year old female is bought to ED by her family after an intentional overdose of ~ 100 ‘diet tablets’ which she ingested 1.5-2 hours earlier.
The Case.
A sunny Saturday morning in Sydney and your 56 year old patient was just outside doing some gardening when they feel a rather sharp bite on their right hand (on webspace between thumb and index finger).
He arrives to the ED distressed and very anxious. His vitals signs are normal and he has localised pain only.
He then hands you this saying “this is the bugger that bit me !!” …..
Where do you go from here ??
The Case.
I was superficially involved in this case of a 32 year old suicidal patient who ingested two full packets of Solian (amisulpride) (~ 24 grams) approximately 90 minutes prior to arrival to ED.
On initial assessment he was GCS 12/15 & had a systolic BP of 115 mmHg.
This is his ECG….
Amisulpride – What is it ?
a benzamide neuroleptic (atypical antipsychotic) with high affinity for the dopamine (specifically D2-2) receptor.
Dose-based Risk Assessment.
Signs & Symptoms.
Disposition.
As a rule; all ingestions > 4 grams should be monitored for at least 16 hours and until all ECG intervals are normal….
ECG: Sinus rhythm @ 83bpm. Normal axis. PR ~200ms. QRS ~120ms. QTc ~560ms !!!
His management (after discussion with our Toxicology gurus) included;
He survived his first night in the ICU….