Ecstatic
Multisystem Processes & Disorders
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M11_F1.jpg"}},{"insert":"\n\n"},{"insert":"It is Monday morning, and as you drive through the usual heavy traffic, your favorite retro station starts playing \u0022Superman\u0022\n\n\u0022That\u0027s what I\u0027m going to be today\u0022, you think, \u0022Superman flying in to save the ER!\u0022, as you turn into the hospital parking lot.\n\nYou walk into the emergency department, still humming the tune.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M11_F2.jpg"}},{"insert":"\n\n"},{"insert":"A couple of seconds later, a nurse hands over the file of the first patient of your shift - Natalie, a 24 year old college student, who has demonstrated altered behavior for the past 24 hours.\n\nApparently, Natalie started partying with her friends on Friday night, and continued to do so over the weekend.\n\nDuring this time, she consumed a fair amount of alcohol, smoked many cigarettes, and used a \u0027little\u0027 cannabis.\n\nStarting from early morning today, Natalie experienced repeated episodes of vomiting, which prompted her friends to call emergency services.\n\nApparently, she was in good health earlier.\n\nA quick perusal of her medical records, which her roommate was smart enough to send along, confirms this.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M11_F3.jpg"}},{"insert":"\n\n"},{"insert":"On examination, you note that Natalie is agitated, and confused in time, place and person.\n\nHer level of hydration appears satisfactory.\n\nNatalie\u0027s temperature, pulse rate, and blood pressure are 99 \u00b0F (37.2 \u00b0C), 112 bpm, and 165\/110 mmHg respectively. Her jugular venous pressure (JVP) is not elevated.\n\nYou find her GCS to be 13\/15 (E4-V4-M5).\n\nThe remainder of the examination is unremarkable. In particular, there are no focal neurological signs, or features of meningism, while both fundi appear normal.\n\nA capillary glucose level is found to be 102 mg\/dL (5.6 mmol\/L), while an ECG reveals only sinus tachycardia.\n\nA urine hCG test is negative.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M11_F4.jpg"}},{"insert":"\n\n"},{"insert":"As you complete the examination and turn from the bed, the nurse approaches you.\n\n\u0022Doctor, I found these in her pocket\u0022\n\nShe shows you a handful of Tablets with \u00228 \u00bd\u0022 imprinted on them.\n\n\u0022I\u0027m pretty sure that this is Ecstasy\u0022, she says, leading you to consider MDMA toxicity.\n\nYou order a series of investigations, including a complete blood count, electrolyte assay, arterial blood gas assay, liver and renal profiles, and a toxicological panel.\n\nAs the nurse prepares to draw the necessary blood samples, she asks you if you\u0027d like to order a plasma MDMA level, in addition to the routine screening tests.\n"}]}
4
{"ops":[{"insert":"How do you respond?\n"}]}
1. "'Yes, knowing the plasma levels will help us manage her properly"
2. "Yes, we might need that for medicolegal purposes later on"
3. "No, that won't really help her management right now"
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