Case Study #3

I lean to suicide attempt via overdose of ?. I defer to you guys with critical care/ER for your immed management. You do all your things but when there's the first chance, drop an NG and see if something comes back for analysis.

He's seeing psych and was released from rehab. Does he see any quality of life?

Just thinking...

PS - are these real case studies or hypothetical ones?

We addressed the fever with tylenol 650mg pr. Pt was tubed to protect airway. And the doc was real interested in what csf might look like.... So what do think happened after tubing?

Lets go over the beginning.

30ish male wheeled to room from triage. Slumped over in wheelchair. Able to move to stretcher with a lot of assistance from 2 staff members. Per parent, pt was "fine today". However, pt went to bathroom, came out, "was not himself, he was lethargic and keeps zoning out, so I brought him in".

Pt responds to touch but cannot or will not answer questions, skin flushed, warm and dry, hr 160, bp 90/50, rectal temp 102.6, rr 28, pulse ox 95. Hx is psych and etoh. Per parent, pt saw psychiatrist this afternoon and was recently released from rehab.

YOU begin to formulate a plan.

The patient needs O2 (nasal cannula), monitor, an IV and labs. In the ED setting... Labs include FSBS (finger stick blood sugar) which is performed on all altered patients of undetermined origin. The labs considered by the MD....CBC w Diff, Chem profile, possibly Cardiac enzymes (at least a CPK) and a liver panel. With the psych/alcohol history tox screen blood (Acetaminophen level) any drug levels, amylase, lipase (pancreatitis) and ETOH level. You obtain a urine tox screen for the standard...a "12-panel urine screen" consists of 12 of the following:

• Amphetamines (including Methamphetamine)
  
• Barbiturates
  
• Benzodiazepines
  
• Buprenorphine
  
• Cannabinoids (THC)
  
• Cocaine
  
• Methadone
  
• Methaqualone
  
• Opioids (Codeine, Morphine, Heroin, Oxycodone, Hydrocodone, etc.)
  
• Phencyclidine (PCP)
  
• Propoxyphene
  
• Synthetic cannabinoids (K2, Spice)
  
• Tricyclic antidepressants
  

Although they all won't be back stat.

You start an IV when you get your labs. The patient is tachy so you consider a EKG/12 lead. The patient is febrile so you do blood cultures and a CXR. YOu monitor the vitals frequently (q 15 min or automatic B/P cuff...we called it a dynamap) for changes.

A CT is ordered due the that patient being altered. The CT is negative.

Suddenly...The patient condition changes. They are showing signs of hypoxia. You change the patient to 100% non rebreather get stat ABG's. It is decided to intubate the patient.

This adds more questions....What do you consider for intubation? How does the nurse prepare? . What is needed to be ready for intubation? After the patient is intubated what is the first nursing task? What do you assess after intubation? What is ordered? What does the patient need now for nursing care after sedation and intubation?

....and yes IV Dantrium is the answer for malignant hyperthermia. Well done.

I would hesitate with the Tylenol as well until tox levels are back

so we are here....what is next?

A CT is ordered due the that patient being altered. The CT is negative.

Suddenly...The patient condition changes. They are showing signs of hypoxia. You change the patient to 100% non rebreather get stat ABG's. It is decided to intubate the patient.

This adds more questions....What do you consider for intubation? How does the nurse prepare? . What is needed to be ready for intubation? After the patient is intubated what is the first nursing task? What do you assess after intubation? What is ordered? What does the patient need now for nursing care after sedation and intubation?