AAAAA
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This is real medicine and real life.
You can wait for at least 8 hrs in a major medical center.
Most pt takes polypharmacy drugs and multiple drugs for overdose and the hx is unreliable. So it is useless to base on hx.
If you are in a small community rural hospital out in northern Minnesota and the pt is a psychiatric pt, he presents with N/V/abdominal pain, then go ahead with NAC.
But in most major center (medical school) I was trained, you wait, wait until the lab result comes back. So in exam, you do not treat until there is proof of toxic level of acetaminophen at least 4 hr. after indestion.
In real life, those pt are well known to you and they come to Er on Saturdays as having fun. So I know they take some Tylenol and normally cut their wrists and make a scene.
Most of time, you wait and draw the blood level within 4 hrs and also base on the clinical symptoms before you give NAC.
You can wait if the level will come back within 8 hr and if elevated, then give NAC.
I saw so many pt who cut their wrists, bleeding from teh radial artery and overdose unknown amount of drugs, I hate to give charcoal.
O MY GOD, Have you give charcoal ?
The first time I gave charcoal, the patient vomited all over me. All the charcoal came back up and shit and everything came out and I can actually look at all the tablets she took !
Most of these pt have chronic ingestion of Tylenol.
The decision to treat with NAC can await determination of acetaminophen levels if this information is avalable within 8 hours.
It it is not avaailbale, TRANSFER the patient to the university center, but you better be damn good to justify the initiation of NAC treatment and call teh ER doc at the other end you have initiate NAC while awaiting laboratory results and then to continue or discontinue the med.
Most small lab DO not do the acetaminophen level and only major university center on Saturdays night will do it.
So when in doubt, give the first dose ONLY !!!!
Initial dose 140mg/kg PO
Then wait for the level if you are at Chicago Hope, Chicago. If the level is high , follow by 17 doses of 70 mg/kg/every 4 hr.
(I normally will give the first dose and wait for the level and decide if I continue to give the next 17 doses)
This is real emergency medicine !
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| AAAAA
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The most reliable way to really know what the patient takes is the patient self-induce vomiting and so many pills/tablets are vomited and then you can confirm what the patient takes.
Unfortunately, most tablets dissolve in an acidic environment in the stomach in less than 2 minutes.
But tablets can sometimes last for 20 minutes or more, so ask the EMS and examine the vomitus , sttill you are not sure what the heck is going on.
So the favour is if you are sure the patient takes acetaminophen, and has symptoms, go ahead to give NAC in rural area.
But in medical center and in exam, you should wait, wait for the lab result to come back !
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| AAAAA
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Sorry, caplets, or capsule can sometimes last for 20 minutes !
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| Jinx
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Thanx AAAAA
that was really helpful and explained very well
u cleared my doubts
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