Notes

Assessment
1. Intentional polysubstance overdose/suicide attempt with Percocet, clonazepam, and alcohol, complicated by opioid toxicity, respiratory depression, and toxic-metabolic encephalopathy; initially required naloxone infusion, now improving.
2. Acetaminophen toxicity, improving on NAC; acetaminophen level downtrending (reported 56 on admission to 8.7 most recently) with mild transaminitis.
3. COVID-19 infection with mild acute hypoxemic respiratory failure; currently on low-flow NC, with crackles/shortness of breath.
4. Acute alcohol intoxication with ongoing risk for withdrawal.
5. Major depressive disorder/anxiety/mood disorder with Baker Act in place after suicide attempt; psychiatry following.
6. Urinary retention.
7. Hypothyroidism / Hashimoto’s / Sheehan syndrome.
8. Chronic pain / rheumatoid arthritis.

Plan
1. Continue stepdown/telemetry with continuous pulse ox and close respiratory/neuro monitoring. Naloxone drip has been stopped; avoid additional sedating medications/opioids/benzodiazepines unless absolutely necessary.
2. Continue/complete N-acetylcysteine per protocol/poison control guidance. Trend CMP/LFTs/INR and acetaminophen levels until medically cleared.
3. Continue COVID isolation. Start/continue dexamethasone 6 mg daily x 7–10 days per ID. No remdesivir per ID. Wean oxygen as tolerated and monitor closely for worsening hypoxemia/work of breathing.
4. Continue CIWA and supportive care for alcohol/opioid withdrawal, including thiamine/folate/MVI and symptomatic meds as needed.
5. Psychiatry to continue following. Maintain Baker Act, suicide precautions, and 1:1 observation. Defer psychiatric medication changes until more medically stable. Plan transfer to inpatient psychiatry once medically cleared. Case management/social work for safe disposition given reported domestic violence concerns.
6. Bladder scans and straight cath PRN; place Foley if recurrent/persistent retention.
7. Resume home levothyroxine when appropriate.
8. Heparin for DVT prophylaxis. Full code.