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:

A 20 year-old patient presents with an overdose of paracetamol.

What are the important factors that need to be considered in order to make a proper risk assessment for the paracetamol poisoning? (more than one answer is correct)

A 70 kg 45-year-old man presents 4 hours following an ingestion of 20x5mg oxycodone. In your ED, he is drowsy but rousable, HR 70 bpm, BP 110/70, RR 6/min, O₂ sat 90% RA, GCS 8 (E1V2M5).

What is the most appropriate treatment for this patient?

A 60kg 19-year-old

university student presents after a weekend of partying and taking

methamphetamine with friends. She complains of feeling anxious with palpitation

and chest pain. In your ED, she looks slightly agitated. Her RR at rest is 24/min, HR

110 bpm, BP 140/90mmHg and her SaO2 is 95% at rest, temp 37°C. ECG shows sinus tachycardia.

What would be the most appropriate management for this patient?

For the same patient, what investigations are needed for the assessment of her paracetamol poisoning?

Choose all the appropriate investigations (more than one answer).

A 16-year-old girl with a history of ADHD is brought to ED by her parents. She is

agitated, restless and complains of palpitation. HR 140 bpm, BP 180/100 mm Hg,

pupils 7 mm. She is hyper-reflexic and looks very anxious. ECG shows sinus tachycardia.

When questioned, she says she has been taking more lisdexamphetamine to help her to perform well in her examinations.

Question: