a suicide attempt
A 22-year-old female is brought into the ED via ambulance because of a suicide attempt. Soon after a “night on the town” she called her boyfriend after a fight and said she took a handful of sleeping pills.
On exam, she is lethargic, but groins and moves all her extremities to painful stimuli. Her blood pressure is 110/70, heart rate is 80 and oxygen saturation 99 percent. Her pupils are normal size and reactive to light. Her deep tendon reflexes are normally bilaterally. In the field she was given an IV bolus of dextrose with an amp or Narcan without response. Her boyfriend, with whom she had an argument brings in a bottle of sleeping medication that reads lorazepam.
What is your diagnosis and differentials? Use VINDICATE
What would be important to know about this patient? Include testing
What is your treatment plan? Explain.
Sample Solution
Based on the presented information, it is most likely that this 22-year-old female was attempting to overdose on her medication and had been given an IV bolus of dextrose with an amp or Narcan without response. Her vital signs are normal with a blood pressure of 110/70, heart rate of 80 and oxygen saturation at 99 percent; indicating that she has not had any major adverse effects from her attempt. Additionally her pupils are normal size and reactive to light as well as having intact deep tendon reflexes bilaterally. Taking all these factors into consideration, this patient presents with a diagnosis of drug intoxication more specifically Benzodiazepine (lorazepam).
Differentials for this case include intoxication by other sedatives such as barbiturates or opioids; however based upon the timing of events combined physical exam findings it appears unlikely in this case since patient responded neither narcan nor glucose given in field prior arrival emergency department (Gendreau et al., 2020).
To arrive at a differential diagnosis it is important to use VINDICATE:
V – Vital Signs: As stated above patient’s vital signs were within normal range.
I – Intake: Patient reported taking lorazepam after “a night out” following argument with boyfriend.
N – Neurologic: Pupils were found be normally sized reactive light along deep tendon reflexes being intact bilaterally.
D – Drugs/Medications:bottle of lorazepam recovered which matches time frame episode.
I – Imaging Studies/Labs :No imaging studies labs performed point due presentation circumstances.
C – Clinical Examination :Patient was lethargic but responsive painful stimuli without any other notable abnormal findings noted during physical exam (Gendreau et al., 2020).
A – Assessments/Tests :Given lack evidence support alternative diagnoses Benzodiazepine intoxication presumed cause symptoms here T – Treatment Plans: In order stabilize patient standard practice would involve establishment airway via intubation if needed followed by reversal agent flumazenil until level consciousness returned back baseline.(Webb & McAllister 2021) <be– evaluation=”” outcome=”” :once=”” alert=”” oriented=”” medical=”” team=”” then=”” monitor=”” further=”” developments=”” including=”” laboratory=”” test=”” assess=”” extent=”” drug=”” ingestion.<=”” b=””>(Webb & McAllister 2021).