Upload
hammer
View
40
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Poisoning. Dr Esther Tsang August 2011. Case 1. 25 year old Vietnamese lady Unable to communicate due to language barrier. Has vomiting for the past one day, and became unconscious today. Friend mentions that she found 10 empty strips of paracetamol next to her. . On examination, - PowerPoint PPT Presentation
Citation preview
Case 1 25 year old Vietnamese lady Unable to communicate due to language
barrier. Has vomiting for the past one day, and
became unconscious today. Friend mentions that she found 10 empty
strips of paracetamol next to her.
On examination, Somnolent, but arousable Confused Localizes pain Opens eyes to pain What is her GCS?
Investigation results : Hb 12.0, TWC 7.0, Plt 200 INR 3.0 APTT 40 TP 65, Alb 39, Glo 39, Bilirubin 15, ALT 789, ALP
30 AST 1000 pH 7.4 HCO3 22 Urea 9.0, creat 139, Na 130, K 4.0 PCM level 100mcg/mL
When does a rise in liver enzymes occur?
Does raised liver enzymes mean acute liver failure? What are the symptoms of acute liver failure?
Where do you send PCM levels to in this hospital?
If the patient is admitted in the middle of the night, can you send PCM levels? If so, how to you go about it and if you don’t, justify.
When should you measure the plasma paracetamol concentration?
If the plasma paracetamol concentration is measured 48 hours later, will this be accurate?
Case 2 40 male brought in by brother because he
drank termite poison 2 hours ago. Patient was restless and uncooperative. He was tearing and drooling. He refuses to stand up because he claims he
is weak.
Nurse tells you the vital signs are as follows : BP 80/40 HR 60 SpO2 89% Reflo 4.5
Can you explain the vital signs?
You examine the patient and find that he is very restless, with M4V2E2
SpO2 worsened to 80% BP 70/30 HR39 Then he has a generalized tonic clonic
seizure.
What would you do now? How to you secure his breathing and airway?
What do you do about his BP and HR?