Quiz Demo

Please note that this case study will be under revision as of April 1st and therefore be temporarily unavailable.

One evening Mr. Brown found his wife sitting on the couch and she was acting strangely. He noted the following symptoms: hallucinations, chills and hot flashes, trembling hands, slurred speech, disorientation and vagueness. Mr. Brown knew that his wife’s psychiatrist had prescribed imipramine (an antidepressant) for treatment of his wife’s depression. Mr. Brown asked his wife what she had taken and she responded “that stuff from the psychiatrist.” He asked her how many pills she had taken. She responded, “not more than ten.”

Mr. Brown telephoned the Emergency Department at the local hospital. The Emergency Room nurses at that hospital had no special training in poison control or dealing with drug overdoses. They did have some reference materials, a written protocol for giving telephone advice and access to the provincial poison control centre.

Nurse B., R.N., answered the telephone in the Emergency Department. Mr. Brown did not identify himself; he asked, “What would happen if someone took six 50 mg. tablets of imipramine?” Nurse B. knew that the medication was an antidepressant, but, was not familiar with the medication. Nurse B. asked Dr. H., a general practitioner who was sitting at the desk, “What would happen if someone took six 50 mg. tablets of imipramine?” Dr. H. replied , “300 mg. is within the therapeutic range.” Nurse B. informed Mr. Brown that the dose was therapeutic. Mr. Brown asked the nurse if the drug could cause hallucinations or confusion. Nurse B. answered “if it did the person would sleep it off.” The conversation ended. Ten minutes later, Dr. H. asked Nurse B. for the caller’s name and telephone number so that he could call the person back. Nurse B. had not obtained that information and she had not documented the call.

Mr. Brown put his wife to bed and checked on her periodically. The last time he checked, Mrs. Brown’s colour was bluish and she was not breathing. Mr. Brown attempted CPR without success. He took Mrs. Brown to the same Emergency Department. The resuscitation efforts at the hospital were not successful and Mrs. Brown was pronounced dead. Mr. Brown has initiated a civil lawsuit alleging that there was a failure to provide appropriate advice when he telephoned the Emergency Department.