From experts to our students! – “Poisoning”

Gastric Lavage and Activated Charcoal Application

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Gastric Lavage and Activated Charcoal Application chapter written by Elif Dilek Cakal from Turkey is just uploaded to the Website!

Give Me A Headache!

Headache

by Matevz Privsek and Gregor Prosen, Slovenia

A 52-year old male comes to the ED with a severe headache. A triage nurse gives you his chart and says that his vital signs are normal, but he does not look well. You start to question the patient, and the following history is obtained: his headache started approximately six hours ago. He was working in his office when he started to feel squeezing-like sensation in his head. The pain has gotten worse since then, but it is still tolerable. It is independent of any physical activity or position. He already had a few similar episodes of this kind of headache in the past two years, but now the pain does not go away after aspirin as it did previously. He denies trauma as well as any associated symptoms, e.g. no visual disturbances, hearing loss, weakness, dizziness, stiff neck, loss of consciousness. He is otherwise a healthy, non-smoker, with no regular therapy or known allergies. His clinical exam is unremarkable. Conscious, GCS 15, alert and oriented, normal skin color. Blood pressure 135/82 mm Hg, pulse 78/min, 14 breaths/min, SpO2 99%, body temperature 36,4 °C. Neurologic exam shows no declines from normal, as well as the rest of the physical exam.

 

slovenia
Matev Privsek, Slovenia
Gregor Prosen, Slovenia

How many headache patients you may encounter today?

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3-5% of all ED patients

So, theoretically, if your ED sees 300 patients a day. You have a chance to see 9-15 patients in 24 hours. Not bad! 3-5 in an 8 hours shift.
Answer

What is your diagnosis ?

You set up an intravenous cannula, draw blood for testing, and gave the patient some parenteral analgesics (metamizole 2.5 g, ketoprofen 100 mg) along with 500 ml of normal saline. You put him into the observation room. Lab results (complete blood count, basic biochemistry panel) came back in 2 hours and are completely normal. The patient now feels much better, with almost no headache at all. Repeated vital signs and clinical exam are again unremarkable. You explain to the patient that most likely he had a tension headache, warn him about red flags regarding headaches, and discharge him home with a prescription for peroral analgesics with a follow-up at his general physician.

Did You Encounter Poisoned Patient Today?

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"Approach to poisoned patients" is one of the core EM clerkship topics!

Poisonings

Harajeshwar Kohli and Ziad Kazzi, USA

An 18-year-old, previously healthy female, presents to the Emergency Department with nausea, vomiting, and tremors. She states 45 minutes ago she ingested an unknown number of diphenhydramine tablets (25 mg) in a suicidal gesture. Past Medical History: Depression, Medications: none. Social History: As per family member, she does not smoke or use illicit drugs. She is single and unemployed. Vital Signs: HR 110 bpm, BP 151/92 mmHg, RR 20 / min, Temp 38.5 degrees Celsius. Physical Exam: General Appearance: Mild distress, awake, appears to be hallucinating. Eyes: Dilated pupils bilaterally but reactive. Cardiovascular: Tachycardic, normal sounds, and no murmurs. Lungs: Clear to auscultation bilaterally. Abdomen: Soft, non-tender, non-distended, decreased bowel sounds. Neurologic: Normal motor power, normal cranial nerves, normal cerebellar exam, alert and oriented to self. Not oriented to location or date. Attention level waxes and wanes. Skin: warm, dry, no rash. Musculoskeletal: No deformities, no clonus, normal deep tendon reflexes.

Drugs Causing Anticholinergic Toxidrome

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Most Common

Tricyclic Antidepressants, Diphenhydramine, Antihistamines, Jimson Weed, and Atropine
Answer

Have you never seen Jimson Weed?

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