chbare Posted September 21, 2013 Author Posted September 21, 2013 Let's say he tolerates PO charcoal. How much do you want to administer? You talk with the patient and indeed he verifies that he ate some of "grandma's candy." This is the only med on board. Patient's overall status remains unchanged. Labs are back and unremarkable. Now what?
triemal04 Posted September 21, 2013 Posted September 21, 2013 1g/kg is pretty standard for a kid, I'd start there. Honestly, at this point I don't think I'd aggressively start treating this kid, especially since the rest of my treatements are reactive, and right now there is nothing to react to. If he's not showing any symptoms then this is a case that charcoal might actually be what really helps. And for all we know he only took 1 pill. He get's to stay with me and will continue to be monitored, but other than that... I'd actually be curious if something that could stop a reaction from happening (lipid emulsion therapy) would be started at this point in a hospital. I'm guessing no, but that's a guess. Pretty sure the other treatments I listed would be held off on and high-dose insulin would also not be started.
MariB Posted September 21, 2013 Posted September 21, 2013 (edited) Has anyone contacted poison control? If after hours or pharmacy not open, I would want someone to bring pill bottle to er if possible. Charcoal sounds good to me if tolerated. We need more info on how many this guy took. Edited September 21, 2013 by MariB
chbare Posted September 21, 2013 Author Posted September 21, 2013 Poison control is unavailable. Let's say he took multiple pills. How long are we going to monitor him? At what point do we let him go if that's what we decide?
triemal04 Posted September 22, 2013 Posted September 22, 2013 Short stay: 24 hours post charcoal admin, and needs to have had a couple of bowel movements. Long stay: until he stops crapping black. This is where a toxicologist comes in because off the top of my head I have no clue.
chbare Posted September 22, 2013 Author Posted September 22, 2013 No worries, prior to grad school, I would not have known one of the points that I hope to discuss here, but I want to make sure we discuss something else as well. Therefore, I will move this scenario in very different directions with the intent of covering two very different concepts. First, let's say a few hours into the clinical course of care the patient begins to develop rather sudden onset lethargy. What do you want to do initially? Put the heart rate and blood pressure away for just a moment and just focus on the change in mental status first.
Kaisu Posted September 22, 2013 Posted September 22, 2013 When would poison control be unavailable? In this teaching scenario In my tiny little brain - beta blocker OD is treated with glucagon. Altered mental status has to be caused by something and if it is a beta blocker OD then it stands to reason there are changes in the ECG and related vital signs. What does the ECG look like? and the vitals? and the kid? how does the kid look?
chbare Posted September 22, 2013 Author Posted September 22, 2013 For the scenario, assume the vital signs are of no use at this time. Focus solely on the altered mental status. Is there something other than cardiac toxicity that Beta blockers can cause, particularly in children?
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