Buy Drug Overdoses Discussion Questions

Buy Drug Overdoses Discussion Questions
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Buy Drug Overdoses Discussion Questions
1. A 22-year-old previously healthy male was brought to the emergency department with nausea,
vomiting, and a decline in mental status. T: 37
°C, HR: 100, BP: 135/90, RR: 20, SpO2
: 92% on
room air. Physical examination revealed pain in the RUQ upon palpation with slight jaundice.
While in the emergency department, his mental status continued to decline precipitously.
AST = 5116, ALT = 4300, PT-INR = 2.1, total bilirubin = 2.1. The patient was transferred to
the ICU. What medication could be started empirically?
A. Methylprednisolone
B. N-acetylcysteine
C. Hepatitis B immunoglobulin
D. Heparin
E. Azathioprine
2. An 84-year-old female with a history of hypertension and dementia presents to the emergency
department with a fever, rigors, and chills. Vital signs: T: 38.9
°C, HR: 110, BP: 70/50, RR: 20,
SpO2
: 99%. After receiving 2.5 Lof crystalloid solution in addition to broad-spectrum
antibiotic therapy (cefepime, metronidazole, and vancomycin), she remains hypotensive and is
started on Levophed. After several days in the ICU, the patient is noticeably more confused. She
had a brief generalized seizure that was treated with Ativan. MRI and LP were negative. EEG
showed triphasic waves with diffuse slowing. What medication may have caused the patient’s
mental status changes in the context of a negative neurological workup?
A. Flagyl
B. Vancomycin
C. Cefepime
D. Levophed
E. Ativan
3. A 23-year-old male with hypermobile joints and vision loss was admitted to the ICU after a CT
scan was concerning for an aortic dissection. He was placed on IV medications to control his
HR and blood pressure. Over the next 24 hours he became lethargic, tachypneic, and short of
breath. T: 37.1
°C, HR: 62, BP: 115/70, RR: 30, SpO2
: 99% on room air. VBG: 7.10/28/90.
Lactate: 6.
What medication is causing this patient’s metabolic derangement?
A. Esmolol
B. Nitroglycerin
C. Labetalol
D. Nitroprusside
E. Nicardipine
4. A 47-year-old apple farmer presented to the emergency department after she was found down.
In the trauma bay, her vital signs were: T: 36
°C, HR: 35, BP: 105/70, RR: 35, SpO2
: 80% on
room air. Physical examination was remarkable for wet and clammy skin with diminished
pulses, bilateral wheezing, and copious secretions. She was intubated with rocuronium and
etomidate. EMT and nursing began to feel ill with diaphoresis. Which pharmacological agent(s)
will improve this patient’s symptoms based on her underlying clinical syndrome?
A. Repeat 0.5 mg of atropine
B. Physostigmine
C. Continuous epinephrine infusion
D. Transcutaneous pacemaker
E. 4 mg of atropine pralidoxime chloride (2-PAM)
5. A 24-year-old previously healthy female graduate student has suffered from multiple witnessed
seizures in the ED and is intubated for airway protection. Per report, EMS said they found
multiple unidentified pill bottles next to her bed. Upon transfer to the ICU she is noted to have
another seizure that occurred after she went into a pulseless wide complex tachycardia. ECG
was obtained and revealed: PR 150, QRS 175, QTc 500 with right axis deviation, wide S in
leads I and aVL, and deep terminal R in lead aVR. On examination, the patient has dilated
pupils and a palpable mass in the suprapubic region. What is the most appropriate next step in
treating this patient?
A. Ammonium chloride
B. Lidocaine
C. Sodium bicarbonate
D. Physostigmine
E. Intralipid Infusion
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