Mock 10

Clinical Scenario for Role Play: Managing Paracetamol Overdose

Background Information:

• You are an FY2 doctor in the Emergency Department.
• Mr. Young Lo, aged 49, has been brought in by ambulance due to a paracetamol overdose.
• He is currently in major Bay-8 and awaiting your immediate assessment and intervention.

Patient Profile:

• Male, 49 years old.
• Presented with a history of paracetamol overdose.

Scenario Setup:

• Assess Mr. Young Lo's immediate medical needs, initiate treatment for the overdose, and consider the need for psychiatric evaluation given the nature of the incident.

Patient Prompts:

1. Initial Assessment:

   • Mr. Lo might be conscious and able to communicate, or he might be in a diminished state depending on the severity and timing of the overdose. If able, he may express concerns such as "What’s going to happen to me?" or "I took a lot of pills."

2. Medical History and Details of Overdose:

   • It's crucial to determine the quantity of paracetamol ingested, the timing of the overdose, and any co-ingestants to accurately assess the risk and plan the management.

Key Actions and Considerations:

• Immediate Medical Evaluation:

  • Conduct a rapid physical examination to assess his vital signs and level of consciousness.
  • Ensure that ABCs (Airway, Breathing, Circulation) are stable.

• History Taking:

  • Quickly ascertain the amount of paracetamol taken, when it was taken, and whether other substances were also ingested.
  • Ask about any previous medical history, including liver disease, which can be exacerbated by paracetamol toxicity.

• Initiate Treatment:

  • If within the window period (usually within 4 hours of ingestion), consider administering activated charcoal to reduce absorption.
  • Begin N-acetylcysteine (NAC) treatment as soon as possible if the dose ingested is at a toxic level according to the paracetamol treatment nomogram, irrespective of the patient's initial presentation. NAC is most effective when started within 8 hours of overdose but can still be beneficial later.

• Laboratory Tests:

  • Order immediate blood work to determine paracetamol levels, liver function tests, coagulation profile, renal function, and blood glucose. These tests help assess the extent of overdose effects and guide further treatment.

• Psychosocial Assessment:

  • Consider the need for a mental health evaluation to understand the context of the overdose, addressing any underlying issues such as depression or suicidal ideation.

• Documentation and Reporting:

  • Document all findings, treatments initiated, and patient's response meticulously.
  • Consider discussing the case with a senior or toxicology consultant for additional guidance and management strategies.

Expected from the Doctor:

• Efficiency and Accuracy:

  • Prompt assessment and initiation of treatment are crucial. Delays can significantly impact the prognosis, particularly regarding liver damage.

• Comprehensive Care:

  • Address both the immediate medical needs and the potential psychological aspects of the overdose.

• Communication:

  • Keep Mr. Lo informed of what treatments are being administered and why, addressing his concerns in a reassuring manner.
  • Ensure clear communication with the multidisciplinary team for an integrated care approach.

• Follow-Up:

  • Arrange for follow-up care including liver function tests and a psychiatric evaluation as needed.

This scenario requires critical actions under pressure, demonstrating your ability to manage acute medical emergencies effectively while also considering the broader implications of a patient's mental health.