Post on 26-Jul-2015
“Jesus”
35y/o male brought in by police, destroyed apartment, yelling that he was Jesus, agitated requiring multiple officers to bring him to ER in handcuffs
P=110, Temp=100F BP190/85 RR=20 No previous psych hx Ativan and Haldol for sedation
“Jesus”
Tox neg, ETOH neg, ASA and APAP neg EKG: sinus tach, nl intervals Eval by mental health Transfer to psych facility
Signout
“Walking Rounds”
“I saw that guy a few days ago and he was normal”
Given Hycodan for cough/bronchitis Cancel psych transfer – admit ICU
ANTICHOLINERGIC TOXICITY
Inhibition of muscarinic cholinergic neurotransmission
“red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare”
Tachycardia, hallucinations, delerium
Case #2 “Agitated”
37 y/o female presents agitated, confused. Family denies any med or drug use. Sick for few days, decrease po intake, nausea.
Patient unable to answer any questions, trying to get off stretcher. Fluctuating level of consciousness, confused.
P=130's BP= 140/80 RR=24 T=37c
“Agitated”
EKG: sinus tach, nl intervals Tox: neg CBC nl, chem nl, creat=2.0 T Bili=5.6 AST=1450 ALT= 5000 APAP=108
Treatment
IV fluids, Ativan IV NAC VIT K (INR=2.3)
Physostigmine for delirium/agitation ICU (Transfer to Boston)
Other Anticholinergics
Military agents/Terrorist agents “Incapacitants” BZ – (3 Quinuclidinyl Benzilate) Agent 15
Case #3 “Too much body fluids”
45 y/o male drank bottle of insecticide as overdose attempt
Vomiting, sweaty, incontinent of urine and feces SOB Restless, anxious, tremulous BP=170/80 P=120 RR=28 T=37 Hazmat suits for decon
Organophosphates Overdose
SLUDGE: salivation, lacrimation, urination, defecation, GI distress, emesis
Don't forget bronchorrhea DUMBELS: diarrhea, urination, miosis,
bronchorrhea, emesis, lacrimation, salivation Inhibits AchE Carbamates, V and G nerve gases similar