Case 17: Overdose

Gary Clarke is a 29 year old who has been brought to A&E after his mother called an ambulance. She found him at home with a bottle of pills and suspects he has taken an overdose.

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HPC

Gary split up with his girlfriend yesterday. He admits to drinking a bottle of vodka today and taking 30 x 50mg amitriptyline tablets thirty minutes before you have seen him. He was found by his mum who called an ambulance and made him come to hospital. He currently feels as if he wants to kill himself and has left a note for his ex-girlfriend to say goodbye.

PMH

Depression / 2 previous overdoses which required inpatient psychiatric assessment

DH

Amitriptyline. NKDA

FH

Nil

SH

Lives with his mum.

Unemployed.

Smokes 15 cigarettes a day, smokes 2 joints of cannabis nightly

Drinks 3-4 pints of lager a day

Initial assessment

A – spontaneously ventilating.

B – Chest clear. RR 24. Sats 98OA.

C – HR 109. BP 146/86. Warm peripheries. Cap Refil < 2. Temp 36.1°C.

D – GCS 15. Blood glucose 4.2mmol/L. Pupils 4+ equal and reactive.

E – abdomen SNT. BS +.

Gary refuses any further investigation. He states that he just wants to kill himself and be left alone to die.

Question 1: What are the key things to look for in Gary’s medical assessment? 

Re-assessment

You are asked to come immediately to see Gary. He has become unresponsive and has been transferred to the resuscitation room.

A – spontaneously ventilating. No added airway sounds. A nasopharyngeal airway is present in the right nostril – placed by nursing sister in resus.

B – chest clear. RR 12. Sats 100% on non-rebreathe mask 15L oxygen.

C – HR 122. BP 100/64. Warm peripheries. Temp 36.8.

D – GCS 9. M5V2E2. Pupils 5+. Not reactive.

E – abdomen SNT. BS -.

2. What are the 2 most important investigations to do now Gary has deteriorated?

Discuss now on Twitter, using the hashtag #quclms. Follow @quclms for updates. Further information and follow-up questions will appear on Twitter throughout the week.

Question setter & Expert: Dr Tim Baruah, ST7 Emergency Medicine, The Royal Free Hospital.

For tips on following hashtags read more, and try one of our recommended Twitter plugins.

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