Emergency Medicine Resident
Case: A 20 year old female was brought in by EMS after being found combative on the street. She is agitated, violent, and yelling nonsense. Initial vital signs are HR 165, BP 170/99, T 101.4, RR 24, O2 sat 60%. After applying oxygen, the patient's saturation improves to 90% but she then has a generalized tonic-clonic seizure. She is intubated for airway protection and hypoxia.
Laboratory workup indicates acute renal insufficiency, elevated LFTs and acidosis. Her acetaminophen/aspirin levels are negative and her EKG shows only sinus tachycardia with normal intervals. Her boyfriend then presents to the ED, stating "all she did was take a tab of Molly tonight".