Thursday, March 3, 2011

Suicidal Ideation

A 25 year old man is brought in by EMS. A suicide note and an empty unlabeled bottle are found next to him. The patient is minimally arousable, hyperthermic, and flushed. Pupils are dilated. Minimal bowel sounds are heard. A Foley catheter is placed and 400cc urine comes out. Fingerstick glucose, acetaminophen, and salicylate levels are fine. Here's an EKG:

You recognize what's going on and push sodium bicarbonate. The EKG changes before your eyes to:
Challenge: What happened?

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3 comments:

  1. arifMarch 3, 2011 at 11:32 PM

    tricyclic poisoning

    ReplyDelete
  2. jbwpacMarch 4, 2011 at 11:25 AM

    TCA overdose !!

    ReplyDelete
  3. CraigMarch 7, 2011 at 9:42 PM

    Nicely done :)
    -
    Suicidal Ideation

    This is tricyclic antidepressant (TCA) overdose; the first EKG shows a prolonged QRS with delayed right ventricular activation and intraventricular conduction delay, manifesting as a deep slurred S in I and aVL and an R in aVR. The treatment is sodium bicarbonate.

    Sources: UpToDate.

    ReplyDelete

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