Multisystem Processes & Disorders


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F3.jpg"}},{"insert":"\n\nA strong cup of coffee and a donut\u2014that\u0027s all you really need for breakfast. Amped up, you walk through the doors of the ED, ready to start your shift.\n\nThe emergency physician on call walks over. After a casual greeting, she briefs you on the patients currently in the ED. Thanks to her competent management, all of them are stable and doing well\u2014except for the most recent patient, who arrived just a couple of minutes ago. \n\nYour colleague shows you to his side and performs a quick briefing.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F5.jpg"}},{"insert":"\n\nPhilip Crow, a 24-year-old student, has presented following an acetaminophen (paracetamol) overdose. He swallowed around forty 500-mg tablets. He did this on the spur of the moment, after his girlfriend broke up with him over the phone. However, he regretted doing so after a while and then called emergency services.\n\nPhilip is quite clear about when he swallowed the tablets, pointing to the time of the call with his girlfriend\u2014just over two hours ago. He states that he did not overdose on any other medications. This is his first attempt at deliberate self-harm. His medical history is unremarkable, and he is not on any medications. He drinks alcohol socially, does not smoke, and denies\u00a0recreational drug use.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M55_F11.jpg"}},{"insert":"\n\nBriefing finished, your colleague prepares to end her shift.\u00a0You thank her and turn towards Phillip. You find out that he is feeling nauseous, and that he has mild abdominal cramps. No other symptoms are present. You take a careful history from scratch, but no new details of note appear.\n\nOn examination, his vital signs are stable. He is conscious, rational, and oriented. The general examination shows no untoward findings. Systems examination shows no other abnormalities either.\n\nBased on a provisional diagnosis of acetaminophen poisoning, you order a complete blood count, a renal profile, and a liver profile. You also order a toxicology screen\u2014just in case.\n"}]}


{"ops":[{"insert":"\u201cShould we start activated charcoal, doctor?\u201d a member of your staff asks.\n\nHow will you respond?\n"}]}
1. Yes
2. No