SAQ 1089 – altered mental state and seizure after stimulant use

A 28-year-old man with known methamphetamine use is brought to a tertiary ED by ambulance after pre-hospital intramuscular droperidol sedation. Observations are temperature 38.4 degrees C, HR 128, BP 158/80, RR 18, oxygen saturation 100% on 6 L by Hudson mask and GCS 9.

Describe five possible causes of this presentation.

(Marked out of 5.0)

/ 5

List five investigations you would perform and give your reasoning.

(Marked out of 5.0)
</p> <table class="saq-prop-table" style="width: 100%; table-layout: fixed; max-width: 100%; border-collapse: collapse;"> <thead> <tr> <th style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">Investigation</th> <th style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">Reasoning</th> </tr> </thead> <tbody> <tr> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">1</td> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">2</td> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">3</td> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">4</td> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">5</td> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;"></td> </tr> </tbody> </table> <p>

/ 5

He promptly has a generalised seizure. Describe your initial management, including drug doses where appropriate.

(Marked out of 5.0)

/ 5

His sodium is 116 mmol/L. Outline the initial management of hyponatraemia and the plan over the next 24 hours.

(Marked out of 4.0)

/ 4

Total Score: 0 / 19

Percentage: 0%