KSEMT122 Posted August 24, 2008 Share Posted August 24, 2008 Ruff is nailing everything on the head in my limited scope of an opinion. The only reason I am even commenting is to commend Ruff for keeping an eye open for the potential of a blood clot. Although at this point it would start to look like that isn't the case. Thank you Ruff. One of the most misdiagnosed things in the ER are PE's. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted August 24, 2008 Share Posted August 24, 2008 Like I said in an earlier post, even though the ibuprofen would be a likely culprit for this overdose there is never any overdose(intentional one) that ever fits the mold of what you would expect. If they say they took one medication intentionally I'd bet donuts to dollars that there is more than one drug that was ingested. The bottles of ibuprofen could have contained Ibuprofen or they could have been a storehouse for any number of other drugs such as tylenol, ASA, narcs, psych meds and many many others. Consider that this is more than likely a multidrug overdose but all the symptoms fit for a very very bad ibuprofen overdose. Treat the seizures, think of RSI since we've given activated charcoal. You need to protect the airway and if she vomits the charcoal and aspirates then she is in real trouble. Protect the airway, stop the seizure and go from there. And remember, death from ibuprofen overdoses are rare(not unheard of though) so if she codes I'll bet it was due to another drug in her system. Remember the valium overdoses you run, don't hear of many straight valium overdoses dying but if they add alcohol to the mix, then it's a whole new ballgame. Link to comment Share on other sites More sharing options...
fireflymedic Posted August 25, 2008 Share Posted August 25, 2008 Ruff - I beat ya to the PE idea lol - check my first post. Anyhow, good call as well - you hit it on the head with an ibuprofen OD. Kudos. On the other hand, I'm not sure I want RSI, I think I'd rather go DAI - I don't want paralytics to mask any further seizure activity and miss treating that. Just my opinion, but that's my thoughts. Of course you do have the option of short term paralytic, but I think DAI would most likely get the job done here just as well. Just somethin to think about. Link to comment Share on other sites More sharing options...
Lone Star Posted August 25, 2008 Share Posted August 25, 2008 Ok, first off, I'll concede to the Ibuprofen OD (been doing lots of research on this one!) Next, a question for Ruffles.... You mentioned activated charcoal as part of your tx, and I think I can understand the reason why, ( to bind withe the ibuprofen instead of letting the body digest it); which leads to my question: wouldn't ipecac also be effective? If I remember correctly, the contraindications would be petroleum distilates or caustic substances, neither of which are applicable here. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted August 25, 2008 Share Posted August 25, 2008 Ipecac will still work when she's unconscious. Get the airway secured if you are gonna give ipecac. It's my understanding that most ambulances do not carry ipecac anymore. Too many risks. Link to comment Share on other sites More sharing options...
zzyzx Posted August 25, 2008 Share Posted August 25, 2008 A 12-lead would be nice too; see if she's got any widened complexes. Can't be sure that this isn't a tricyclic OD since she may not have told her mom that she's on anti-depressants. Link to comment Share on other sites More sharing options...
firedoc5 Posted August 25, 2008 Share Posted August 25, 2008 Advil-Ibuprofen allergy...Like me. It's almost identical to what I have with ASA or Ibuprofen as of about three years ago. Link to comment Share on other sites More sharing options...
Jessi Posted August 26, 2008 Author Share Posted August 26, 2008 en route to the hospital you call and give your report to let them know what youre bringing in. when you give the nurse her last name she tells you that she had just been released a week earlier from the psych ward b/c of a similar episode. the bottles you had seen were the larger bottles(the ones that have 100+ pills) and since there were 2 (you guessed it) she's done it before the mom finally breaks down and tells you that she's been repeatedly trying to kill herself ever since her boyfriend broke up with her. there were no other drugs in the bottle other than the ibuprofen and although she took several ativan out of her moms purse the night before. no alcohol was involved you get her airway secured and get the seizures under control. no widened complexes are shown on the 12-lead. you turn her over to the ER staff and complete your report. you check in on her a week later and find that she's once again been admitted to the psych ward and wont soon be released. Link to comment Share on other sites More sharing options...
wbgraidermom Posted August 26, 2008 Share Posted August 26, 2008 first i would like to slap the hell out of the mom to get her to shut up so i could get what i needed and then take things from there. mom out of control is not going to be able to give you information, but one that has calmed down and slapped backed to earth will. Link to comment Share on other sites More sharing options...
firedoc5 Posted August 28, 2008 Share Posted August 28, 2008 It's amazing how many people have tried to get attention by taking motrin or Tylenol. I know of a couple of people that did the Tylenol thing. It did kill them in the end. It was from cirrhosis of the liver due to damage from the Tylenol, a long, painful, way to go. Link to comment Share on other sites More sharing options...
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