CASE#1

A 16-year-old woman presents to your emergency department with her family member
She admits to having taken 25 acetaminophen tablets (500 mg each) approximately
three hours prior to arrival. She has had three episodes of emesis in the past 30
minutes.
Physical
T: 98.6°FExamination:
HR: 80 bpm RR: 16 breaths per minute BP: 110/60 mm Hg
General: Alert and oriented.
HEENT: Pupils 3 mm bilaterally and reactive.
Pulmonary: Clear to auscultation.
CV: Regular rate and rhythm, without murmur.
Abdomen: Soft, nontender, no masses palpable.
Neurologic: GCS 15.

1. Should treatment with gastric lavage be used this patient? What treatment, if any,
would you administer? What testing, if any, should be ordered?
2. The patient’s acetaminophen level at four hours post-ingestion is 224 mcg/ml. What
treatment, if any, is indicated now? How would you give it?
3. If administered on the patient’s initial presentation, would charcoal interfere with the
activity of the antidote?
 CASE#2
A 3-year-old girl is rushed into the Emergency Department carried by her frantic
mother. The mother states that the child just consumed “a bottle of heart pills.” The
mother and the patient were apparently visiting the patient’s grandmother this
afternoon, when the mother discovered her daughter playing in the bedroom with an
open bottle of pills. The bottle was labeled “digoxin 0.25 mg tablets,” and there were
10 left. The Grandmother estimated that there were probably 40 pills in the bottle this
morning when she took her usual dose. Since the child had been playing alone for
some time, the ingestion could have occurred anytime within the past 90 minutes.
Physical
T: 99.4°FExamination:
HR: 40 bpm RR: 30 breaths per minute BP: 98/52 mm Hg
Weight 33 pounds (15 kg)
General: Age appropriate, lethargic female, whimpering and whining in the bed.
Responds irritably to any stimuli. There are no signs of trauma.
Pulmonary: Clear to auscultation.
CV: Bradycardic, regular rhythm.
Initial EKG shows sinus bradycardia with first degree AV block.
Bedside glucose: 84
1. What tests would be appropriate in this case?
2. What therapy would you recommend and how much would you give?