Doczilla Posted March 7, 2009 Share Posted March 7, 2009 Does she say it's dirty because it looks yellow to her from her dig toxicity? 'zilla Link to comment Share on other sites More sharing options...
itku2er Posted March 7, 2009 Share Posted March 7, 2009 I was off base I was thinking some kind of OCD behaviour. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted March 7, 2009 Author Share Posted March 7, 2009 Does she say it's dirty because it looks yellow to her from her dig toxicity? 'zilla Ding Ding Ding One of the s/s of digoxin toxicity is yellow-green field of vision. The recently worsened Alzheimer's led to improper self-medication. I'm sure the Alzheimer's and lethargy from the OD led to her not being able to realize she'd been redoing the same task and realizing her own vision problems. Some other signs of digitalis toxicity include: Bradycardia, heart blocks, VT, VF, other vision problems (blurriness), confusion, H/A, N/V/D, anorexia, palpitations, SOB Good thoughts going down the psych route, but want to make sure the ABC's and physical stuff check out, too. So, to finish things off, how would we treat this? (with dosages and mechanism of action) Link to comment Share on other sites More sharing options...
Doczilla Posted March 7, 2009 Share Posted March 7, 2009 Of course, her dig toxicity may be due to sepsis, dehydration, potassium deficiency, or other factors. The scrubbing may be simply delirium due to sepsis, UTI, dehydration, dig toxicity, or her other medications. The question is, do you want to treat presumptively for dig toxicity in the field with her vitals in the absence of definitive diagnostic information? 'zilla Link to comment Share on other sites More sharing options...
Jeepluv77 Posted March 7, 2009 Share Posted March 7, 2009 Establish at least one iv. Atropine can be used to prevent heart block. Monitor resperations closely and be prepared to treat any compromise. We would need ekg results to determine which antidysrythmic to use. Which is where I am stuck. I don't even start my acls till the 16th. I can however find the answer if given time. I'm good at the research. Link to comment Share on other sites More sharing options...
joesph Posted March 8, 2009 Share Posted March 8, 2009 OK first off nice detective work you guys. at my level o2, transport, initiate IV in route, notify med control of findings and upgrade to als at their discretion or if patient worsens. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted March 8, 2009 Author Share Posted March 8, 2009 Of course, her dig toxicity may be due to sepsis, dehydration, potassium deficiency, or other factors. The scrubbing may be simply delirium due to sepsis, UTI, dehydration, dig toxicity, or her other medications. The question is, do you want to treat presumptively for dig toxicity in the field with her vitals in the absence of definitive diagnostic information? 'zilla Good points. We got this scenario while going over antidote drugs, so we didn't get passed the "which of these six drugs would you give" question specific to that lecture. I don't know if it'd be enough, but what I was trying to get others to say say was look for those other signs of dehydration, sepsis, hypokalemia, etc which she would have been negative for...at least the ones one can look for in the field...but I suppose there's no way to really rule out in the field. What state would patient have to be in for people to try to fix dig toxicity in the field? Link to comment Share on other sites More sharing options...
spenac Posted March 8, 2009 Share Posted March 8, 2009 Anthony thanks for a very educational scenario. Link to comment Share on other sites More sharing options...
Lone Star Posted March 8, 2009 Share Posted March 8, 2009 I've heard stories about cataract surgeries that have had the patients complaining of a 'yellow tint' to everything after the surgery. Someting about not being treated to filter (or tone down) yellows..... Link to comment Share on other sites More sharing options...
Doczilla Posted March 8, 2009 Share Posted March 8, 2009 Then let's up the stakes. Same patient, same presentation, different vitals. Alert, disoriented. Multifocal Atrial tachycardia with superimposed 3rd degree block (pathognomonic for dig toxicity) Ventricular rate (and pulse) 30 BP 70/40 What do you want to do? You get one choice. Pace, or drug. Don't just guess; justify your answer as to why one is better than the other. 'zilla Link to comment Share on other sites More sharing options...
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