A 54-year-old man is brought in by ambulance and police. He was

found not rousable on the street. The ambulance team thinks he might have

injected heroin. At the scene, his GCS was 15 then deteriorated to 10 enroute.

On examination in the ED, his RR is 10/min, SaO2 92% on room

air, HR 100/min, BP 90/70 mm Hg. He has pin-point pupils. You note a fresh IV

access mark (track mark) on the left side of his neck.

You have secured IV access and placed him on

cardiorespiratory monitoring with supplemental oxygen. His GCS is 8. HR 100

bpm, BP 85/50 mm Hg, RR drops to 4/min. SAO2 86% on oxygen.

Question:

A 23-year-old woman is brought to the ED by federal police from the

airport. They think she has ingested large amounts of drugs during her flight

from Bali. In fact, a female undercover policewoman witnessed her ingestion of

multiple bags of white substance in the toilet just before arrival at the

Sydney airport.

On examination, she looks well and has denied the ingestion

of any substance other than food. After her CT abdomen -pelvis, where several

discrete “packages” are evident, she admits to the ingestion of drugs. HR 100 bpm, BP 120/70 mm Hg, temp 36.5°C, RR

14/min, O2sat 98% on room air.

Question:

A 29-year-old man presents by ambulance after taking an

unknown amount of promethazine. The estimated time of ingestion is about 1 hour ago. His HR 90 bpm, BP 120/80 mm Hg. He is mildly confused but co-operative. What method of decontamination is most appropriate for him?

A 38-year-old man is brought in by ambulance after an

intentional overdose of paracetamol of 500 mgx20 tablets. He is regretful of

his action and called the ambulance 7 hours after ingestion. HR 90 bpm, BP 120/80 mm Hg temperature 37.3°C. 

Question:

An 80-year-old woman is brought in by her partner due to

recurrent episodes of syncope which are witnessed. There are no prodromal

symptoms. She is on metoprolol for hypertension and it was recently increased from 25 mg twice daily to 50 mg twice daily. 

On examination, she looks well. She does not describe any

prodromal symptoms prior to her syncopal episodes. On examination, HR 40 bpm, BP 130/80 mm Hg.

Question:

A 25-year-old woman, 50 kg, presents with nausea, vomiting and

abdominal pain for the last few hours. She has dental pain and has been taking 1g paracetamol orally every 4 hours for the last 3 days. 

What is the most appropriate treatment for this patient?

With

the patients above, which of the following is the most likely contaminant in the

herbal tea?

A 39-year-old man and his wife are brought in by ambulance

to the ED due to disorientation and agitation. They were found by neighbours,

wandering in their street.  The ambulance

team says they seemed to have drunk a herbal tea that morning.

On examination, they are disoriented with tachycardia,

dilated pupils, dry mucous membranes, dry skin and urinary retention.

Question:

A 35-year-old male is brought in by ambulance with an overdose of

paracetamol. He was found by neighbours alone in his unit. He had written a

suicide note that says he took 50 tablets of 500mg, dated 3 days ago.

On arrival, he is jaundiced. HR 105, BP 105/90, RR 24, Temp

36.1. He is unable to follow commands and is disorientated to time place and

person.

His pathology findings are:

• Bilirubin 82umol/L (1-20)
• ALT 3890 U/L (5-40)
• AST 7257 U/L (5-30)
• Alkaline phosphatase 178 U/L (30-110)
• Creatinine 0.30 mmol/L (0.60-0.11)
• INR 6.9 (< 1.5)
• Paracetamol level is 22 mg/L

A 45-year-old man is brought in by his wife. He accidentally

ingested unknown concentration of bleach thinking it was a sports drink. His airway is

patent, he has no stridor, there is no erythema or swelling in the mouth. He

complained of pain on swallowing and finds it hard to drink fluid. His HR 80 bpm, BP 120/80 mm hg, RR 14 bpm and

SaO2 98% room air.

Question: