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Case Presentations of the Harvard Affiliated Emergency Medicine Residencies| Volume 57, ISSUE 3, P387-389, September 2019

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Acute Intoxication

  • Kelsy E. Greenwald
    Affiliations
    Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts

    Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts

    Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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  • David A. Peak
    Affiliations
    Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts

    Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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  • Kathleen Wittels
    Affiliations
    Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts

    Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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  • Susan R. Wilcox
    Correspondence
    Reprint Address: Susan R. Wilcox, md, Department of Emergency Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114
    Affiliations
    Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts

    Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
    Search for articles by this author
      Dr. Kelsy Greenwald: This is a case of a 27-year-old male who was brought to our emergency department (ED) by security after he was found unresponsive in the lobby of the hospital. Almost immediately upon arrival to the ED, clinicians were called to his bedside for somnolence with shallow breathing. His pupils were 3 mm bilaterally. An i.v. line was inserted and he was given 0.4 mg naloxone i.v. for a suspected narcotic overdose, after which he awoke. He then stated that he was in the hospital because he has a seizure disorder and had not been taking his medication. He was placed on a monitor and his initial vitals were otherwise unremarkable. He was afebrile, with a heart rate of 60 beats/min, blood pressure 137/90 mm Hg, respiratory rate 14 breaths/min, and oxygen saturation 99% on room air. However, during further questioning, he would have intermittent episodes of unresponsiveness, lasting 30 s to 1 min, with staring and drooling. These would resolve spontaneously, and he was breathing spontaneously throughout.
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      References

        • The 190th General Court of the Commonwealth of Massachusetts
        “General Laws, Part I, Title XVII, Chapter 123, Section 12.” MA Legislature.
        (Available at:)
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