Case studies on opiates & Opioids intoxication
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1. A 22-year-old male patient was brought to the emergency department by EMS in a comatose state with pinpoint pupils, low blood pressure and oxygen levels, and coarse lung sounds, suggestive of opioid intoxication. 2. A 29-year-old male with a history of tramadol addiction presented after ingesting 5 tramadol tablets, appearing drowsy but oriented. His vitals were stable and pupils reactive, indicating a need for decontamination and monitoring. 3. A 25-year-old male with a history of drug use and family troubles presented after sudden onset of seizures and then coma. His vitals were stable with a slightly low bicar
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This document discusses the evaluation of chest pain in an outpatient setting. It begins by stating that the initial goals are to rule out acute coronary syndrome (ACS) and other life-threatening conditions. Common causes of chest pain in an outpatient setting include chest wall pain, gastroesophageal reflux disease (GERD), and costochondritis. More serious potential causes include ACS, pulmonary embolism, aortic dissection, and pneumonia. The document reviews the likelihood ratios and characteristics for diagnosing various potential causes of chest pain. It also discusses appropriate use of stress testing and who should be urgently referred to the emergency department for evaluation.Management of hypertension
Management of hypertensionKerolus Shehata
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This document provides guidance on the management of hypertension. It begins with educational objectives and a case study example. It then reviews the magnitude of hypertension, definitions of true hypertension versus white coat hypertension, and the role of ambulatory blood pressure monitoring. Guidelines for diagnosing and staging hypertension from ACC/AHA and JNC-8 are presented. Non-pharmacologic and pharmacologic treatment options are discussed, including diuretics, ACE inhibitors, ARBs, beta blockers, calcium channel blockers, and vasodilators. Resistant hypertension, hypertensive crises, and hypertension management in specific clinical contexts like stroke are also addressed. Recommendations are provided for evaluating and managing different patient cases.Anticoagulation in venous thromboembolism
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- The 44-year-old man presented with an unprovoked left proximal leg deep venous thrombosis 3 months ago and has since been stable on warfarin therapy with therapeutic INR levels. For unprovoked proximal DVT, guidelines recommend extended anticoagulation therapy indefinitely due to the risk of recurrence, unless the patient has a high bleeding risk. Therefore, the most appropriate management would be to continue anticoagulation indefinitely (Option A).Hyperglycemic crises and hypoglycemia
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This document discusses the management of hyperglycemic crises including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). It provides guidelines on the identification and treatment of these conditions. It presents a case study of a patient with vomiting and elevated blood glucose and ketones who is diagnosed with DKA. It covers the diagnostic criteria, precipitants, signs and symptoms, pathophysiology, treatment including fluid resuscitation and insulin therapy, complications, and discharge planning for DKA and HHS. Hypoglycemia is also discussed including causes, outcomes, and treatment approaches.Left Bundle Branch Block (LBBB)
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- Left bundle branch block (LBBB) is caused by conditions that damage the left bundle branch, such as hypertension, dilated cardiomyopathy, and ischemic heart disease.
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惠惠悋 悋惓悸 惡悋惆悧 悋悒愕惺悋悋惠 悋悖悸 悖悋惺 悋悒惶悋惡悋惠 悋愀悋惘悧悸 惓 悋悴惘忰 悋忰惘 悋悒愃悋悄 悸 悋惠惺悋 惺悋 忰悋悸 忰悋悸 悋惶悋惡 悋忰惆 悋惷悋惺悋惠 悋忰惠悸. 惠愆 悋惠惺悋惠 悸 惠惆 悋愕悋惺惆悸 忰悋悋惠 悋慍 悋悒惶悋惡悋惠 悋惘悖愕悸 悋惠愕 惠惘 悒惘愆悋惆悋惠 惺悋悸 悋悖悸 悒 忰 惶 悋愀悋 悋愀惡. 悋 惠忰惠 惺 惶悋悧忰 忰惆惆悸 惠惺悋 惺 悋忰惘 悋悒惶悋惡悋惠 悋悋悧悸.Ad
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Case studies on opiates & Opioids intoxication
- 1. By Kerolus Ekram Gad Shehata PGY-III IM Resident, Ain Shams University ECFMG certified Case studies on Opiate/Opioids Intoxication
- 2. 22 YO M pt. accompanied to the PCC with the EMS in a coma, no response to pain, GCS is 5, cold extremities, with pinpoint pupils, chest auscultations reveals bilateral coarse crepitations. B.P: 90/50 Pulse: 64 RR: 7 ABG: PH: 7.21, PCO2: 65, PO2: 50, SaO2: 72, Hco3: 20 What is the FIRST thing to do? Then you will do., .., .? What do you think about D.Ds? Can it be something Not toxicology-related? Will you refer this patient even if Not toxicology-related? Will you refer this patient to CT scan before admission? Will you give antidote if available? What if it is Not available?
- 3. 29 YO M pt. accompanied by his brother who claims an overdose of Tramadol 5 tablets 2 hours ago, he is a known tramadol addict with a usual daily dose of 3 tablets. Pt. looks drowsy, but oriented to TPP. Pupils are 3 mm B/L and reactive. His chest was clear B.P: 100/70, Pulse: 82, RR: 15 ABG: PH: 7.34, Pco2: 47, Hco3: 19, Sao2: 96% What is the most appropriate decontamination measure for this pt.? What will be your decision? What is the mechanism of 1500 ml IV fluids? What are the precautions of this method? What to start with? What If the same presentations happened in a 7 YO child accidentally? What are the kind of fluids that you will give? What about the outcome?
- 4. 25 YO M pt. accompanied with his family C/O sudden onset of convulsions, blueness of lips then coma 1 hour ago. He is a known addict and there are some social troubles at home. The patient looks disoriented, with some response to pain. Pupils are 4 mm B/L. Chest is clear and No signs of lateralization. B.P: 120/70, Pulse: 82, RR: 18 ABG: PH: 7.22, PCO2: 42, HCo3: 13, SaO2: 94%, PO2: 87 What is you most likely diagnosis? What is the most Important D.D? CENTRAL CAUSE Will you do CT scan now? What type of fluid to start with? Why? Will you administer Na Bicarbonate? How many hours should the pt. be observed? What if he start seizing in the ER?