Poisoning and Overdose 247241.You receive notification from EMS that they are bringing in a 17-year-
old male who was found unconscious by a police officer. The police officer
at the scene states that he snuck up on a group of kids that he thought were
using drugs. Two of them got away and one just fell to the ground seconds
after standing up. Lying on the ground next to the adolescent were plastic
bags. The emergency medical technician states that the patient was in ven-
tricular fibrillation. He was shocked in the field and is now in a sinus
rhythm. The EMT also administered IV dextrose, thiamine, and naloxone
without any change in mental status. Which of the following substances
was the patient most likely abusing?
a. Butane
b. Ethanol
c. Heroin
d. Cocaine
e. PCP
242.A 61-year-old man with a history of depression and hypertension is
brought to the ED by EMS for altered mental status. The patient’s wife states
that he stopped taking his fluoxetine 1 month ago and now only takes meto-
prolol for his hypertension. The patient’s BP is 75/40 mm Hg, HR is 39 beats
per minute, RR is 14 breaths per minute, oxygen saturation is 99% on 100%
oxygen, and fingerstick glucose is 81 mg/dL. The patient is awake and moan-
ing, responding only to deep stimuli. You suspect an overdose of metoprolol.
You endotracheally intubate the patient for airway control. Which of the fol-
lowing is the most appropriate next step in management?
a. Syrup of ipecac, normal saline bolus, epinephrine
b. Cardioversion with 200 J then administer epinephrine
c. Cardioversion with 200 J then administer atropine
d. Normal saline bolus, atropine, epinephrine, and activated charcoal
e. Normal saline bolus, atropine, glucagon, and activated charcoal