Overdose or tbi? What would you do?

[BAP16]

Female 21yo of average height and weight brought into ED with diminished level of conscious (responded to sternum rub), vomiting, confusion, low bp, low ox level, and bradycardia.

Friend who brought her in claimed she had one drink at a bar then told him something was wrong. He brought her in after she began losing consciousness.

Based on symptoms and history, we narrowed it down to alcohol intoxication, drug overdose, or a head injury.

I got off my ed shift before a diagnosis was made, so I'll update below once I can find out tomorrow.

What would your protocols be in a case like this? When a pt is brought in with unknown loc? Stabilize and treat for drugs and alcohol overdose and run tests for head injury?

[sailornurse]

Welcome to AN. I see you just joined a few hours ago. Per the TOS terms of service we cannot give medical advice.

[BAP16]

Hi sailornurse, thanks for the welcome. I know you can't give advice. I've been reading for a long time, but haven't had a real question until now.

I am no longer at work and not treating the pt so was more curious what would happen in different places for this situation. I'm still new in the ed so I haven't seen it yet.

[Lunah, MSN, RN]

First focus in such a scenario would be correcting immediate life threats (ABCs). Fix the oxygenation issues, hypotension, and bradycardia, and ultimately stabilize for CT to check that noggin. Tox screens (UA and ETOH), and don't ever forget to check a dexy (blood sugar, Accucheck, glucose, whatever you call it in your area) on your unconscious/unresponsive peeps.

[Lev, MSN, RN, NP]

We would treat both. Head CT to rule out bleed. Urine tox screen, tylenol and salicylate levels, etoh level, contact with poison center, IV fluids, oxygen, possibly treat the bradycardia, check electrolytes, CBC, maybe a LP if looks infectious

[AZQuik]

Doesn't really sound like etoh. She should be tachycardic from diuretics and hypoxia. Unless she has crumped that far and gets tubed.

I've seen a lot of that with spice but they usually come in hopped up and restrained.

DKA with some comorbidities can present in some freaky ways, but this doesn't sound DKA. Still, a few labs can start you thinking that way.

No fever? Opiate of with sepsis could look similar.

I don't know as far as diagnosis without more info

[Lunah, MSN, RN]

Sounds like somebody slipped something in her drink.

[jenniam]

I'm commenting to find out what happened (not an ER nurse). I would also think she had something slipped into her drink.

[adamRn79, BSN, RN]

Roofy

[BAP16]

I'm commenting to find out what happened (not an ER nurse). I would also think she had something slipped into her drink.

You guys called it. Tests came back positive for opioids and she apparently responded well to treatment. They intubated to secure her airway. After she was extubated and came back to her wits, she was adamant that someone must have drugged her because she had only one drink and has never done drugs.

I've never heard of opiods being used for date rape, but slipping random pain pills into a drink seems like a college kid thing to do. Anyone else seen this?

[CraigB-RN, MSN, RN]

Or it could be proof that Dr. House was corrected again.

"Everybody Lies"

Would take a fair amount of something to have that effect without affecting the taste/texture of the drink.

[Altra, BSN, RN]

CraigB, RN's post above does highlight a true phenomenon: "someone slipped something into my (my friend's) drink" is used to deflect judgement/consequences of experimentation.

However, it is also true that drug-facilitated sexual assault is a major public health issue, and perpetrators are often not very sophisticated or subtle in their attempts. You can google some CDC statistics on the subject.