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Heroin OD

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 40-year-old male with a history of heroin abuse on methadone is brought to the ED for a possible overdose.  He did not require Narcan but is somnolent.  He has no complaint but does mention he has chronic low back pain and requests pain medicine.  He denies any fever, weakness or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal.  Physical exam is normal except for a crazy amount of track marks

Initial Differential Diagnosis: 

Relevant Test Results:

  • Imaging: below

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows osteomyelitis at 2 levels.
  2. What should you do next?  MRI to check for discitis and epidural abscess
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

PLACE PAGE HERE

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CASE CONCLUSION: We’ll just have to see

CASE LESSONS:

  1. Always
  2. Never
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