IV heroin User......DAY 1

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IV heroin User......DAY 1

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6 Posts

Delusional
Forum Elite

Topics: 41
Posts: 226

06/23/03 - 06:33 AM

This is a 28 year old heroin IV user whom we will be talking about in the upcoming days........We will follow his serious clincial condition day by day till we achieve the following objectives:

1....learn the presentation of this clinical condition
2....learn the different causes of this clinical entity
3....learn to diagnose it and differentiate it from other DDx
4....learn to treat it and anticipate serious complications of the treatment and manage them...

Please feel free to post ur replies with answers or suggestions......And rememeber the faster you try to participate the quicker we would be moving .......

It starts like this....28 year old male IV heroin user presents to the ER with a heroin overdose....hypotensive and unconsious with bradycardia and pinpoint pupils....his repsiratory rate was 8/min
he was given Naloxone, Glucose and thiamine
He began improving and regaining consciousness only to become tachpenic and short of breath....
Examination revealed a hypoxic patient with B/L diffuse rales on chest exam....
ABG revealed a wide A a gradient of 28 ...... an emergency CXR revealed B/L interstitial infiltrates......
100% O2 failed to improve his ABG
What is ur next step in management?

1.... IV furosemide 40 mg
2.... IV nitrogycerine
3.... Swan-Ganz catheterization
4.... Intubate and place on PEEP
5.... Give additional naloxone

Hope to see ur replies with comments......
and then we'd be moving into the next day with this patient.....

bikram
Forum Newbie

Topics: 7
Posts: 25

06/23/03 - 08:45 AM

ARDS SO GIVE OXY BY PEEP

soltres

06/23/03 - 11:38 PM

mechanical respiration w/ peep

Delusional
Forum Elite

Topics: 41
Posts: 226

06/24/03 - 12:55 AM

Yes Bikram and Soltres......Very Good :-({|= :icon_thumb: :icon_king:
This is ARDS from narcotic overdose.....and the treatment has to be emergent esp if the patient is not responding to High O2 sat......which is predominantly mechanical ventilation with PEEP or CPAP......

Now before we continue with the next scenario with this case....We have some questions.......
at the end of this whole thing ....i will post a summary of all the important points to rememebr about this clinical condition....after we finish....

Now here r the Questions.........( you do not necessarliy need to attempt all the questions....Attempt the ones you think you can or go ahead and answer them all.....)

1.....this is narcotic overdose ass. ARDS....what is the most common drug overdose that causes ARDS ?

2.... this patient was given his sat. O2 and wasn't responding....what is the most common cause of not resonding to high O2 in a hypoxemic patient.

3....If a case of ARDS comes in the exam or in real life what r usually the precipitating factors other than the narcotic overdose the patient came with.....?

4.....What is the differential diagnosis and what is the best test to differentiate them......?

If anyone has any objection or suggestions to the way this topic or any other of my topics is being addressed please let me know ....just PM me

prep4usmle
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Topics: 288
Posts: 1,187

06/24/03 - 02:00 AM

3....If a case of ARDS comes in the exam or in real life what r usually the precipitating factors other than the narcotic overdose the patient came with.....?

Probably most common causes of ADRS are sepsis and severe trauma.

Some other conditions associated with ADRS:
-drug overdose, toxic gases (including too much O2), climbing on Himalaya too fast
-radiation pneumonitis, severe burns
-aspiration (gastric content, water-near drowning)
-hypovolemia, hypertransfusion, DIC, any shock
-embolism (thromb, fat...), lymphatic obstruction
-post-operative, post-cardioversion, cardiopulmon bypass
-pancreatitis (enzymes)
-intracranial bleeding

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Delusional
Forum Elite

Topics: 41
Posts: 226

06/25/03 - 03:27 PM

Thanx Prep4usmle......
That is very correct......
These are the causes if ARDS....ones which i assume wld be asked about on the exam wld be...

1....Gram -ve sepsis
2....Severe trauma or burns
3....mutliple packed cell transfusion
4....severe pancreatitis
5....Various drug toxicities...narcotic was depicted here in this case...

again i will answer the 1st question which is what is the most common drug overdose that causes ARDS and it is basicaly TCA toxicity
Question 3 has been answered by thankfully answered by Prep4usmle....

what is left is question 2 and 4

Question 2..........I wld suppose a hypoxemic patient who is given 100% O2 and shows no improvement is a very good clue on the exam to what disorder.....
ARDS is obviously treated with intubation and PEEP with delivery of O2...the abnormality i am mentioning is hypoxemia that will not be corrected with any form of ventilation......

Question 4........There is only one clinical entity that shld be differentiated from ARDS because it shows similar signs and symptoms......
what is it? and how are they both differentiated...?

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