Owen Wilson Attempts Suicide
Owen Wilson, the quirky star of college humor movies like Wedding Crashers and You, Me, and Dupree as well as cult faves like Bottle Roclet, is recovering at Cedars Sinai Medical Center today, one day after being rushed to St. John’s hospital in Santa Monica, Calif. on Sunday, August 26, by ambulance following a 911 call.
The rumor around the web is that Wilson was found by his brother after attempting suicide and found with some type of intoxication as well as superficial wrist cuts, according to the National Enquirer.
Wilson has released a statement saying, “I respectfully ask that the media allow me to receive care and heal in private during this difficult time.”
Well, there’s not too much to say about this from a medical standpoint. Obviously, we do not enjoy trivializing something that is so serious with our presumptive diagnoses. However, the point of the article is to provide some medical background about a condition that nearly resulted in a demise.
Let’s make a few assumptions first (and we know the risk about assumptions but for the purpose of the article we must make some as we do not have the facts). We are not going to delve into the ‘why’ of the suicide attempt (if that it is indeed what it was), because if someone is so distraught as to attempt ending their own life, there must be an element of major depression or bipolar disorder and we are not psychiatrists.
Instead, let us assume that Wilson swallowed too many pills and discuss the results of toxic ingestions, which have an overall mortality rate that is less than 1%. One might further rationalize that he either made a call to someone before or after the ingestion as he was found in prior to losing consciousness.
The physicians would approach the patient like all others and obtain a set of vital signs which include heart rate, blood pressure, oxygen saturation and respiration frequency. In addition, for toxic exposure patients, their pupils and mental status are equally important. These characteristics may differ significantly depending on the ingested substance e.g., if it was a sedative, his pulse rate and BP would most likely would be low as would his respiration frequency despite having a low oxygen saturation. Other clues to a sedative ingestion would be dilated pupils and somnolence. On the other hand, if he took a bunch of speed his pupils would be miotic (or constricted) and he would be tachycardic, hypertensive and probably tachypneic as well. Importantly, he might also be alert and able to relay some type of history.
Intravenous access should be obtained (usually by the ambulance), and the airway should be assessed with a short threshold for endotracheal intubation (putting a breathing tube in) if there is doubt about the patient’s ability to protect that airway and avoid aspiration. In essence, patients who are sedated may not receive the normal stimulus to breathe, or, they may not be able to protect their own airway from objects not supposed to be entering it (e.g. vomit, blood, digested food).
Whether or not the doctors give charcoal or lavage his GI tract (aka “pumped his stomach”) would be based upon the specific poison(s) ingested, time from ingestion to presentation, presenting symptoms, and predicted severity of poisoning. However as one can easily picture, these patients are not the best historians and in fact have a vested interest in not telling you what they ingested (if they were serious about the suicide attempt). Thus, some type of GI decontamination is routinely recommended for all patients unless the agent ingested was clearly nontoxic.
Nowadays, many EDs will empirically give naloxone to reverse opiate overdose if there is even the smallest suspicion that this is the cause. If you are on the TV show House you can send your residents to search the patient’s residence for whatever s/he might have ingested but in the real world we usually depend on the patient’s friends or relatives to relay this information.
There are a host of typical physical exam findings that tip docs off to specific agents - e.g. pupil size and movement, odors, skin findings, temperature, and alterations in HR and BP – but there is not enough room on the page to cover them all. Also, some poisons cause typical changes on the electrocardiogram; even x-rays can be helpful, particularly in the case of drug mules, whose swallowed packets usually show up on plain films (e.g chest x-rays).
After initial assessment and empiric treatment, toxicology screens for typical drugs of abuse and ingested poisons can be sent (especially to look for things like acetaminophen, the outcome of which is exquisitely dependent on time).
If the agent is discovered quickly, the proper therapy should be instituted ASAP. With a targeted history and physical, a detailed physical exam and prompt supportive therapy, the vast majority of patients will stay alive until a more specific antidote can be given. A call to the poison control center should invariably be made to ask for guidance and report an ingestion.
Here are some addtional interesting facts from the 2001 annual report of the American Association of Poison Control Centers toxic exposure surveillance system:
• While only 1-2% of hospitalized patients died from their toxic ingestion, 59 percent of poison fatalities occurred in individuals aged 20 to 49
• The most commonly implicated poisoning exposures were due to pain medications (10.6 percent),
• Sedative-hypnotics and cough and cold preparations each accounted for about 4-5% of poison exposures.
2007-08-28
