02-29-2008, 05:37 AM
A 19-year-old man comes to the emergency department after a suicide attempt. He is crying and not entirely coherent, but says that he swallowed most of a bottle of over-the-counter-pain medication about 2 to 4 hours ago. He thinks the medication was a combination of acetaminophen and codeine, but is uncertain. His blood pressure is 130/76 mm Hg, pulse is 74/min, and respirations are 18/min. Physical examination reveals an agitated but well-appearing young man. An initial acetaminophen level is undetectable, although the patient's urine is positive for opioids. A nasogastric tube is placed, and lavage is started. A nurse is attempting to contact family members to have the pill bottle brought to the hospital. Which of the following is the most appropriate next step in the management?
Please select 1 correct answer.
1)Immediately administer N-acetylcysteine
2)Begin hemodialysis
3)Admit to monitored unit for observation
4)Recheck acetaminophen level in 2 hours
5)Start naloxone infusion
Please select 1 correct answer.
1)Immediately administer N-acetylcysteine
2)Begin hemodialysis
3)Admit to monitored unit for observation
4)Recheck acetaminophen level in 2 hours
5)Start naloxone infusion