Here We Go....Again

[Chief1C]

Any bleeding? Urine, stool; odd colors?

[spoil:315b45ed53]I guess if one followed the empty bottles of Advil, one could say the symptoms could relate to an overdose of Ibuprofen (Advil); and may have lead to organ or heart failure. I'm just winging it, using the plethora of useless information and hunches that every patient lies and has something to hide.[/spoil:315b45ed53]

[Lone Star]

Was there any difficulty breathing BEFORE she went to bed?

[Just Plain Ruff]

ok, she's overdosed on Advil for starters and I'll rule that out later.

I'm gonna get her (if she's not already on it) 15lpm nrb

IV At least 1

here are the symptoms of ibu overdose

Some more side effects are unsteadiness, blurred vision, ringing in the ears, gastrointestinal, nausea plus vomiting, diarrhea, stomach pain, probable loss of blood in intestinal areas or stomach or both, headache, agitation, drowsiness, incoherence and confusion etc. Sometimes more serious symptoms are also noticed in some victims though very rare such as seizure, gastrointestinal bleeding, metabolic acidosis, respiratory depression, hyperkalaemia, tachycardia, atrial fibrillation, coma, hepatic dysfunction, renal failure, cyanosis, and cardiac arrest etc. Until and unless the victim is allergic to ibuprofen, there is a slim chance that the victim would die from Ibuprofen Overdose.

I'm also gonna give at least 1 bottle of activated charcoal in the ambulance only and ONLY if her airway will allow it.

I have been doing some research into this type of overdose and deaths are not common but we have to go on the assumption that she has taken other drugs with this. So even though death from ibuprofen is uncommon drugs that are mixed with ibuprofen will be the cause of her death if she dies.

So get the charcoal on board and get to the ER.

Treat seizures if they occur

treat airway problems if they occur

Treat any other problems as they occur.

[Lone Star]

I'm having a 'problem' with the assumption that the 'couple of half empty bottles of Advil' were 'half emptied' at one time. There's nothing to indicate how old (or new) those bottles are!

Logic would dictate that if you're going to intentionally overdose on anything, you wouldn't take only 'some' of one bottle, then open another and take only 'some of those'. If it were an intentional (or even accidental) overdose, wouldn't it stand to reason that you'd work on one bottle till it was gone, before opening the second one?

[Just Plain Ruff]

logic would stand here but when was the last overdose you ran logical. Maybe the bottles were all half empty and she finished them up today?

I can't think of the last time I ran a overdose that was a cut and dried overdose. There are always nuances but if you look at my symptoms I listed she is showing some pretty hallmark symptoms of an ibuprofen overdose.

The activated charcoal is not gonig to hurt her and it will only hurt you if she pukes all over you because then your uniform is ruined.

But I can remember a overdose I ran once were the patient took one pill from each of his bottles over a period of 5 hours. It didn't help that he was a holistic healer and he had over 2000 pill bottles of different stuff. He said he took 1 pill from each bottle. logical I think not. He died. And the nurses were really pissed that I brought in all 2000 pill bottles. Sure some were the same but that didn't matter to this guy. We ended up coding him about 15 minutes into the transport. I've never seen such an overdose so I'm going to run on the assumption of that she's an overdose and keep a high index of suspicion of this being an overdose.

[fireflymedic]

I'm not gonna jump onto the OD bandwagon totally yet, however, it is a possibility to be considered though it's not quite fitting the total pic of a ibuprofen OD (yet) perhaps it's still early in the course though. If patient is allergic to asprin though, there is that concern with taking advil there may be a possible reaction to any ibuprofen product as well. Had an acetomenaphin OD not long ago that didn't quite fit the picture, but sure as day that was it. With suicidals you just never know. Treat symptoms - can she speak to me? If she can then find out how much (if any) advil was taken and if she is in fact allergic to asa. Either way, you're going to have to treat the breathing difficulty so go high flow O2 going, along with neb treatment to clear up those wheezes (a clear sign of lower airway constriction) and get that SPO2 up from 94%. With her BP what it is, she would tolerate a neb just fine without skyrocketing her BP and pulse at 108 (a little tachy, but not bad). With skin being cool and diaphoretic, this is sounding an awful lot like a med reaction of some sort (my guess is to the advil). Just to be certain we're not having an anxiety issue, any tetany in hands/feet? Feeling lightheaded? What meds is this girl on ? I'm going with this is a med reaction headed towards anaphylaxis if we don't do above interventions....that's my vote

[mshow00]

I have to agree with Ruff here... only I would add ETOH to the equation.

[Jessi]

There is no ETOH on board and she is becoming very incoherent. She says that there isn't anying numbness/tingling but her headache is getting worse and her vision is starting to get "fuzzy" and she says her stomach is hurting really bad. en route she becomes harder to keep awake. she's speaking to you in 2-3 words sentences and refuses to tell you if she has taken anything or not.

she's on 15 lpm/ NR which brings her sats up to 96%.

Vitals:

BP- 108/66

P- 116

Resp - 12 labored, accessory muscle use noted

skin - pale, diaphoretic

Lung Sounds - wheezing is more pronounced

She loses conciousness and starts to actively seize. what's next?

[fireflymedic]

Aight, that's it I'm on the ibuprofen OD wagon now - too many things fit and she's refusing to tell you whether she took anything or not. What do I see on the monitor? With her actively seizing, I'm taking control of airway as I expect the vomiting to come- DAI to prevent masking further seizure activity and control seizures with benzos - versed is benzo of choice for me. I'm gonna use versed 2-4 mg and fentanyl 50-100mcg to bring her down to tube. Do we see any hyperthermia here? Control any arhythmias - treat as presents. Could go either tachy which she is now, but with seizure activity may brady down. Drop an NG tube down her as well since we gave the charcoal which if this is ibuprofen OD certainly didn't hurt the situation. Blurry vision could be due to nystgmus. Watch her for kidney/liver issues, monitor urine output if long transport (ie in my case she wins a foley as well), be alert for metabolic acidosis especially with the seizure activity which may be a precursor to it. Let's definitely get fluids in this girl and try to flush some out and help preserve kidney function. She's headed for bad news if not already there....this one is sounding alot like my tylenol OD more and more....

[ERDoc]

Never assume that the meds that were in the bottle were actually what was listed on the bottle.