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Supratherapeutic Paracetamol Overdose

This case describes a therapeutic excess of paracetamol and explores the further management of complications in an unintentional paracetamol overdose.
30 questions. 30 minutes. Test yourself against your colleagues!
How will you manage haemodynamic instability in a patient following a calcium channel blocker drug overdose?
Your pre-alert phone rings to warn you that a 30-year-old male will be arriving in five minutes, having been found collapsed with blue lips and recordable oxygen saturations.
Acute dystonia is a movement disorder in which there is a state of abnormal tone produced by slow and sustained contractions of opposing muscle groups.
Acute dystonia is a common presentation to the ED. Most cases occur as a result of recreational or prescribed drugs.
Angioedema and Urticaria (hives) are part of a spectrum of allergic symptoms and occasionally have a non-allergic aetiology.
ECG changes in an unconscious patient
A 69-year-old man presents to the ED with a heart rate of 28bpm. He is hypotensive and clammy.
An older woman with a background of alcohol excess has an unusual blood gas. What is causing her drowsiness and how will you treat it?
This module explores the presentations of children to the ED by concerned parents after a potential ingestion of a substance is common.
This module explores the presentations of children to the ED by concerned parents after a potential ingestion of a substance is common.
A patient presents following a viral illness with RUQ pain, vomiting and confusion.
A patient having a large laceration sutured suddenly goes into cardiac arrest.
Carbon monoxide poisoning still accounts for a significant number of cases and is associated with both morbidity and mortality through a spectrum of presentations due to both acute and chronic exposures.
Carbon monoxide poisoning still accounts for a significant number of cases and is associated with both morbidity and mortality through a spectrum of presentations due to both acute and chronic exposures.
A 35-year-old lady is brought to the ED by her husband after developing acute confusion, vomiting and unsteadiness on her feet.
A 45-year-old man is brought to ED after his neighbours call an ambulance, concerned that he looks 'unwell'.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A 55-year-old man is brought in with fatigue and headache.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
The use of FI blocks in the emergency department has been shown to provide effective pain relief in the acute setting and to reduce the use of opiate analgesia.
The use of FI blocks in the emergency department has been shown to provide effective pain relief in the acute setting and to reduce the use of opiate analgesia.
Supraventricular Tachycardias can be divided into three pathophysiologicaly distinct conditions.
This module is designed to help you understand the principles, basic physiology, and clinical features of supraventricular tachycardias. It is written from a clinical standpoint, with testing based on scenarios, and the main text based on ECG interpretation.
A young man is brought to your ED by police. They suspect he has concealed drugs internally and want you to perform an intimate search and x-ray.
Management of a patient who reattends the Emergency Department with cyclical nausea and vomiting.
RCEM, Advanced Life Support, ALS, shockable rhythm, non- shockable rhythm, cardiac arrest, resuscitation, resus.
A 2-year-old female presents to your Emergency Department after biting into a liquid detergent capsule
A 45-year-old female attended the ED after taking an intentional antifreeze overdose.
A 24-year-old farmer presents to the ED with vomiting, diarrhoea and neck fasciculations.
A young woman, who walks into the ED with Propranolol overdose, suddenly collapses.
Recap of the ASC 2022 conference
A 63-year-old female with a background of type I diabetes mellitus, chronic pancreatitis and COPD presents to the ED with confusion and hypoglycaemia.
This session considers the three main forms of drug related hyperthermia, malignant hyperthermia, neuroleptic malignant syndrome and serotonin syndrome.
This session considers the three main forms of drug related hyperthermia, malignant hyperthermia, neuroleptic malignant syndrome and serotonin syndrome.
A 52-year-old male electrician presents in the ED with a complaint of abdominal pain.
You are met with a patient who you believe is suffering an anaphylactic reaction, however the adrenaline is not having the desired effect. Why might this be and what would you do next?
An unconscious male presents to the ED after being pulled from a burning building.
This module covers indications for propofol sedation, identifying at risk patients, a standardised procedure, strategies for addressing adverse events, a section on advanced procedural sedation and all the relevant governance issues.
Local anaesthetics are amongst the most widely used drugs in any emergency department. It is, therefore, essential that emergency medicine clinicians can use these drugs safely and effectively.
You are asked to see a 51-year-old lady who has been taken to the resus room. The ambulance crew tell you she has taken an overdose 5 hours previously.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A previously fit and well, fully immunised 10-month-old is brought into your ED with a 3 hour history of drowsiness.
A 65-year-old man with a neck of femur fracture becomes acutely unwell after a fascia iliaca block.
A farmer is found collapsed near the sheep dip bath. What do you think could have happened?
A 20-year-old presents to the ED after taking about 20 tablets of an unknown medication.
From somewhere under the sea, sun... and food container.
A 29-year-old male presents after being poisoned with an unknown drug.
A 50-year-old male is brought in by ambulance with acute confusion and aggression.
A 20-year-old female was brought into the ED as a pre-alert call. She had been found unresponsive in her room at a psychiatric unit.
Hypoxia is common in patients presenting to the ED and can be life-threatening. The differentials are wide and include cardiac, respiratory and haematological causes
Methaemoglobinaemia is a life-threatening cause of hypoxia and death but is reversible with early recognition and treatment.
Regular attender is brought to ED with low GCS with suspicion of intoxication in cold winter season.
A 25-year-old male presents with a five day history of bilateral muscular leg pain.
A patient presents to the Emergency Department suspected of having illicit concealed drugs. This SAQ explores the clinical management, combined with the ethical and medicolegal aspects of their care.
A 38-year-old gentleman has just finished a course of antibiotics for pneumonia, but his symptoms aren’t resolving
A 62-year-old patient went too far with a seemingly benign ingredient in her kitchen.
Why digoxin? Digoxin has a narrow therapeutic index and digoxin toxicity can be a life-threatening condition.
A woman is found unresponsive in a takeaway at midnight. She is hypotensive, drowsy and has low oxygen saturations. She is unable to give a history and there is nobody with her. Can you help her?
An elderly gentleman presented with lethargy and poor oral intake. As routine tests begin they reveal he has more than just an AKI that needs treatment.
A 22-year-old healthy male attends ED with sudden onset of headache. He reports taking 100 mg Sildenafil before the headache started. On examination there is right arm weakness.
This session aims to illustrate, through a series of clinical cases, the common presentations and complications of acute kidney injury (AKI).
A 35-year-old presents with paraesthesia and weakness in both lower limbs.
A 16-year-old is brought in by ambulance to your resuscitation room with a reduced level of consciousness and then starts to see monkeys everywhere. What’s going on?
Chemical incidents usually happen following leaks, explosions or fires in industrial settings
This session describes the most common childhood exanthems that present to emergency departments
Patients frequently attend the emergency department (ED) with episodes of cutaneous and mucosal swelling.
You receive a standby call for red-flag sepsis – Initial pattern recognition triggers the pathway. Shortly after arriving you experience ‘pattern interrupt’ and ponder new evidence in the treatment of this condition.
An 84-year-old woman presents to emergency department with new confusion and weakness.
You receive a sepsis pre-alert for a 39 year old female who is brought in by ambulance vomiting. She has muscle aches and a fever for 5 days. She is triaged to Covid resus. Her blood gas isn’t pretty. What are we missing?
Sedation is a routine aspect of emergency care. The aim is clear: make the procedural experience as comfortable as possible for your patient, whilst ensuring that your practice is safe.
Discussing the indications for procedural sedation
A 50-year-old female presents to the emergency department after drinking antifreeze.
While working in the minors area of a busy teaching hospital's ED, a somewhat flustered junior doctor approaches you to confess her actions.
A 94-year-old female with dementia was referred to the ED from her residential home. She had a 2 day history of anorexia, lethargy and loose stools 3 times a day.
This session will focus on secondary causes of acute severe headaches that are likely to present to an emergency department.
A 46-year-old female patient presents as she keeps falling over and is no longer able to feed herself
The child with decreased consciousness is a common problem with many possible diagnoses and potentially high mortality and morbidity.
The child with decreased consciousness is a common problem with many possible diagnoses and potentially high mortality and morbidity
A case of Ataxia and weakness of limbs in a teenage male
It is a busy winter evening in the Emergency Department. The next patient to be seen is a 37-year-old female presenting with a headache, nausea and general malaise.
A 46-year-old man is brought by ambulance to the Emergency Department. He has been drinking alcohol all afternoon and according to collateral from his wife he had taken ‘some tablets’ two hours ago.
A 36-year-old female, with a previous history of asthma, was brought to the emergency department at 1840hrs on a Saturday afternoon
This month we have 2 sections. Part 1 we discuss Timing of endoscopy, New in EM Haloperidol for migraine, New in EM Drugs v DCC in A Fib. Part 2 we discuss the RCEM guideline on suspected internal drug traffickers
A 50-year-old female presents with acute confusion and vomiting
A 40-year-old man had a seizure which was witnessed by his wife; she reported that he was unresponsive and all limbs were shaking
A 38-year-old gentleman reattends obtunded and narcosed after being treated for a DVT the day before.
A 60-year-old man presented to the emergency department with a 1 week history of increasing lethargy, intermittent tingling in both arms and palpitations
Why is this a hot topic? It is a sign of serious distress. It is common. It is strongly associated with suicide. Suicide is one of commonest causes death in young people. 200% increase in self harm 1985-1995. If ever you have the opportunity to save a young persons life - it is now.
New in EM XueBiJing for pneumonia, Renal Colic Live guidlines, DFTB19 Paul Reavley, DFTB19 Anna Dobbie, New in EM Intralipid in OD
Management of opiate overdose is simple. ABCDE assessment, support of oxygenation and respiration as necessary, and antagonise with naloxone if toxicity is severe. Everyone has their own take on it. But what about the ongoing care?
This month we have Guideline CVA part 2 | Paper 1 - New in EM cervical artery dissection | Belfast CPD 2019 Acute Ophthalmology | New in EM: NACSTOP trial - early cessation of NAC in paracetamol OD | EMEC Anu Mitra
This month we discuss Cannabis hyperemesis syndrome and interpreting and verifying the index test
It's Friday evening and you're at work in the ED (where else would you rather be??). Jack is a 15 year old boy who has taken an overdose of paracetamol a couple of hours ago. He texted his girlfriend soon after and she called an ambulance
Approximately 10% of all admissions to the Emergency Department (ED) are related to patients having a mental health crisis.  With the ever increasing numbers of patients requiring mental health input, it is important that we understand the law that underpins our treatment (RCEM, 2018)
August 2018 Podcast
You've just arrived for your first ED shift, excited to be allocated to resus. The red phone rings. A 45-year-old female, amitriptyline overdose, P120, BP85/45, GCS 5, ETA 5 minutes.
The relative tranquillity of the night shift thus was about to be broken. I swallowed my apprehension and walked outside.
The latest podcast from the RCEMLearning team
This is a hugely common presentation in the ED and often one many doctors try to avoid
The February Podcast from the Team
January 2018
Temp Taking and how to Take it by Andy Neill, A new Dawn for Stroke Patients by Nikki Abela, and Arrest Asthma by James Yates
So the TOXABSE guidelines for staggered paracetamol overdose last night. We bring you an up to date podcast on paracetamol overdose management recorded at the recent RCEM scientific conference with James Dear
The RCEMLearning podcast for November 2017
The new podcast for August 2017
Welcome back to the RCEM Learning podcast for May 2017
Welcome to the new format podcast. From now on you'll be getting a monthly podcast with lots of different segments to try and cover as much as we possibly can
Day 3 at #RCEMBelfast continued on yesterday’s medical thread, with an excellent talk on Heart Failure by consultant Cardiologist Mark Petrie
A topic to muddy the FOAMed waters; constipation, a problem for many patients in which their care could be dramatically improved. Find out how in this podcast
A podcast about one of the most frequent presentations and poisoning seen in the ED
Learn about a rare type of poisoning which is cropping across the UK
Struggling to find a resource on how to approach the IDU, check out this podcast
Class A drug in the UK - illegal to possess, give away or sell. Possession can be punished with 7 years in jail