Psychiatric emergencies

Question 1

Signs of opiate overdose

Answer 1

• respiratory depression
• hypotension and tachycardia
• usually pinpoint pupils

Question 2

Investigations to order in opiate OD

Answer 2

INITIALLY:

• therapeutic trial of naloxone
• ECG

Then:

• paracetamol blood level
• FBC, metabolic screen, glucose, U&Es, CK, ABG
• CXR if pulmonary oedema suspected

Question 3

How to give naloxone in opiate OD

Answer 3

IV, initially 400 micrograms, then 800 micrograms for up to 2 doses at 1 minute intervals if no response; then increased to 2mg for 1 dose (4mg may be required in seriously poisoned patients), review diagnosis, further doses may be required

IM if no vein available

observe for recurrence of CNS depression!

Question 4

Presentation of serotonin syndrome

Answer 4

• autonomic instability: sweaty (diaphoresis), high temp, GI disturbance
• CNS: confusion, agitation
• neuro: (cog-wheel) rigidity, myoclonus, tremor, hyperreflexia

Question 5

Presentation of neuroleptic malignant syndrome

Answer 5

• muscle stiffness/rigidity
• delirium/altered consciousness
• autonomic instability: fever, tachycardia, labile BP
• raised CRP, raised WCC