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iHuman Case

Amka Oxendine

Pre-work & All Sections with

Answer & SBAR note.

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Patient Name: Amka Oxendine

Age : 19 y/o

Height & Weight: F, 5’3”, 127 lbs.

Dx: Acute acetaminophen ingestion

Brought vis EMS to ER with c/o abd pain with nausea. EMS reports ingestion of acetaminophen for SI. 58

kg. Full Code. VS q1hr x4, a2hr, q4hr. NPO. NKDA. SI precautions until psychiatrist

Denies ingestion of salicylates, ETOH or other substances within in 24 hr. Four hours later after waking up

had second thoughts and call EMS.

58 kg. Full Code. VS q1hr x4, a2hr, q4hr. NPO. NIKA. SI precautions until psychiatrist

1. What is your primary concers for this patient and what assessments and interventions

would be associated with your concerns and why?

My primary concern would be to assess for Airway Breathing Circulation- SOB, CP, and

palpitations. I would assess for unusual bleeding as a priority. Next I would perform a

neurovascular check, noting PERRLA. I would also be aware of s/s of liver failure: anorexia, n/v,

fatigue, excessive sweating and confusion.

The interventions I would perform:

1. Assessing time of ingestion***, Quantity/Strength, and reason.

2. Consider evaluating for other co-ingestions (e.g., salicylates, tricyclic

antidepressants, ethanol, ethylene glycol, methanol) especially since this is a known

suicide attempt.

3. Since patients with acetaminophen toxicity can develop not only liver failure, but also

renal failure, coagulopathy due to liver failure, and acid base disturbances, will monitor for

the following additional labs (serum creatinine, urinalysis, lactic acid level, arterial blood

gas, venous blood gas). Serial labs will likely be needed to determine the clinical course of

the patient.

4. Utilize oxygen therapy if pt is noted to be in respiratory distress.

5. Give IV fluid and draw labs for Paracetamol blood level.

6. Provide antidote of N-acetylcysteine as prescribed.

7. Activated charcoal should be administered as soon as possible, usually within 1- 2 hours

of the exposure as prescribed.

2. What medications do you anticipate the health care provider would prescribe while

the patient is in the hospital and why?

1. Activated charcoal to halt the absorption of acetaminophen in the stomach

typically within 1-2 hours of exposure. It acts by binding to the pharmaceutical drugs

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