Intoxication

Low complexity — Central Nervous System

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