Intoxication

Goals

1. Recognise a compromised airway due to reduced consciousness using the ABCDE method.
2. Name the treatment for an (opioid) intoxication and apply it.

Anamnese

• Name: Mr Koster
• Age: 64 years
• Family: Married
• Occupation: Shop owner
• Cultural: Not known

AMPLE

• A.Unknown
• M.Pantoprazole, oxycodone (OxyNorm), fentanyl patch
• P.Compression fracture of vertebra L1, chronic back pain, gastric ulcer
• L.Unknown
• E.Increasing pain complaints

SBAR

• S.Mr Koster is admitted to your ward due to increasing pain from a compression fracture of vertebra L1. You are now asked to go and check on him because he is difficult to arouse.
• B.Mr Koster is 64 years old and has a history of compression fracture of vertebra L1, chronic back pain and gastric ulcer.
• A.See ABCDE
• R.Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

• A.Clear airway, responsive to voice.
• B.RR 12 breaths/min, normal depth, symmetrical thoracic excursions, normal jugular veins, normal breath sounds, saturation 91%.
• C.Normal colour, CRT 2 sec, HR 87 bpm, strong regular pulse, skin cold, BP 138/59.
• D.Voice on AVPU, glucose 5.8, pinpoint pupils.
• E.Temp 36.4°C, no oedema. Urine output: spontaneous 450 ml 2 hours ago.

Situation at the end of scenario

• A.Clear airway, responsive to pain stimulus.
• B.RR 9 breaths/min, symmetrical thoracic excursions, normal jugular veins, normal breath sounds, saturation 88%.
• C.Greyish colour, CRT 2 sec, HR 92 bpm, strong regular pulse, skin cold, BP 137/61.
• D.Pain on AVPU, glucose 5.8, pinpoint pupils.
• E.Temp 36.3°C, no oedema.

Recommendations

• Reassess pain medication