Intoxication

Mid complexity — Central Nervous System

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