Return to Scenario ListShow Learning Points most relevant to Phase 1:


Clinical Discipline(s)/Organ System(s)
Emergency Medicine, Psychiatry/Health Psychology, Clinical Pharmacology
Progress Test Topic(s)
Mental health
You are accompanying the Emergency Department registrar when a 24 year old NZ European woman is brought in by a friend. She is drowsy but adamant that she does not want to be in the hospital. Her friend informs you that she was found surrounded by empty paracetamol packs and an empty bottle of vodka. The friend is unable to tell you how long ago she took the pills but they report that she does suffer from depression (though isn't sure if she is prescribed antidepressant medication). When you approach the patient she becomes irritable and demands to leave the hospital, yelling at you that she does not need treating.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Help-seeking behaviour of young people: barriers and enablers
   - Intoxication, misuse, abuse and dependence definitions
   - Drug absorption, metabolism and excretion
   - List common drugs used in overdose and their antidotes
   - Awareness of a variety of violent and non-violent methods of self-harm including cutting, shooting, drowning, hanging, high-speed impact, jumping from a height, neglect and the risk levels associated with these
   - Toxicity of paracetamol, aspirin, lithium, organophosphate, tricyclic antidepressants, benzodiazepines, zopiclone, carbon monoxide and other common substances used in overdose
Clinical and Communication Skills 
   - Elicit a patient and/or collateral history when someone has taken an overdose and assess for concurrent mental illness
   - Perform an examination (including mental state) of a patient who has self-harmed; recognise stigmata of self-harm
   - Perform a risk assessment for harm to self or others; assess suicide and neglect risk; consider static and dynamic risk factors
   - Management of intoxication in the Emergency Department; de-escalation skills and restraint
   - Interpret relevant investigations: electrolytes, hormonal screening, urine and other toxicology screens, carboxy-haemoglobin level, ECG, imaging
   - Interpret the paracetamol treatment nomogram
   - Differential diagnosis of suicidal behaviour
   - Differential diagnosis of overdose and other states of altered consciousness
   - Management of overdose: generally supportive measures, decontamination and specific antidotes
   - Course and prognosis of patients who have taken overdoses
   - Role of security in Emergency Department, role of consultation-liaison psychiatry, crisis care services and early intervention services
Personal and Professional Skills 
   - Best interests principle
   - Show empathy
   - Social impact of mental illness
   - Awareness of the impact of a patient yelling at you - your feelings, and reactions
   - Mental Health Act application and criteria for compulsory admission
   - Non-judgemental approach to mental illness (i.e. stigma reduction)
   - Your attitude to a patient who has taken an overdose, and who may be a similar age to yourself
   - Patient privacy and confidentiality
   - Capacity and ability to consent
   - Refusal of medical treatment
Hauora Māori 
   - Suicide rates in Māori youth and young people
   - Awareness of differing risk profiles for Māori presenting with suicide attempts including racism, deprivation, unemployment
   - Consideration of access to cultural/spiritual support for patient and whānau
   - Ensuring a culturally safe environment in mental health disorders including cultural references in suicide ideation (e.g. mataku or mate Māori)
Population Health 
   - Epidemiology of self-harm methods and completed suicide
   - Suicide trends in New Zealand population groups
   - Population methods to reduce suicide and overdoses
   - Prevention strategies to target those at risk of suicide
Conditions to be considered relating to this scenario
paracetamol overdose, depression, organophosphate poisoning, opioid overdose, benzodiazepine overdose, amphetamine overdose, methamphetamine overdose, tricyclic antidepressant overdose, atypical antipsychotic overdose, beta-blocker overdose, aspirin overdose, substance abuse, borderline personality disorder, bipolar affective disorder, schizophrenia
Less common but 'important not to miss'
systemic lupus erythematosus (SLE), ethylene glycol poisoning, methanol poisoning, multiple sclerosis