Intoxication

Goals

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

Anamnese

• Name: Mr van Vliet
• Age: 58 years
• Family: Unmarried
• Occupation: Taxidermist
• Cultural: Not known

AMPLE

• A.Unknown
• M.Aspirin, diclofenac, oxycodone IR, oxycodone MR, fentanyl patch
• P.NSTEMI, hyperthyroidism, metastatic renal cell carcinoma
• L.Unknown
• E.Increasing pain due to impending spinal cord compression

SBAR

• S.Mr van Vliet is admitted to your ward due to increasing pain from an impending spinal cord compression caused by a metastatic renal cell carcinoma. You are now asked to check on him because he is difficult to rouse.
• B.Mr van Vliet is 58 years old and has a history of NSTEMI, hyperthyroidism and renal cell carcinoma.
• A.See ABCDE
• R.Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

• A.Compromised airway, snoring breathing.
• B.RR 12 breaths/min, normal depth, symmetrical thoracic excursions, normal jugular veins, normal breath sounds, saturation 88%.
• C.Normal colour, CRT 2 sec, HR 85 bpm, strong regular pulse, skin lukewarm, BP 145/52.
• D.Voice on AVPU, glucose 5.1, pupils pinpoints.
• E.Temp 35.8°C, no oedema. Urine output: spontaneous 350 ml 2 hours ago.

Situation at the end of scenario

• A.Compromised airway, snoring breathing.
• B.RR 12 breaths/min, normal depth, symmetrical thoracic excursions, normal jugular veins, normal breath sounds, saturation 85%.
• C.Ashen colour, CRT 2 sec, HR 102 bpm, strong regular pulse, skin lukewarm, BP 152/60.
• D.Pain on AVPU, glucose 5.1, pupils pinpoints.
• E.Temp 35.8°C, no oedema.

Recommendations

• Re-evaluate pain medication