EM CCM Conference: October 2013 BETA-BLOCKER TOXICITY PRESENTED BY DR. KENDALL SUMMARY BY DR. YOUN The Case: HISTORY: 91F with HTN, DM on carvedilol, labetalol BIBEMS for weakness, dizziness, and near-syncope. VITALS: BP 76/38, HR 41 PRIMARY INTERVENTIONS: Intubation, fluids, atropine, dopamine drip, pacer pads applied PHYSICAL:, Read more…
Thanks to Dr. Paulson for today’s Morning Report! Toxicology Corner The bat phone rings: “There’s a fire in the area, how many critical/non-critical beds do you have?” Dr. Silverberg: “1 million of each” Carbon Monoxide (CO) and Cyanide exposure Carbon Monoxide – Rapidly absorbed across the alveolar membrane Read more…
Thanks to Dr. Gichinga for today’s Morning Report! Carbamazepine Toxicity Carbamazepine (5H-dibenzazepine-5-carboxamide) is an iminostilbene derivative with a tricyclic structure. It is an antiepileptic drug widely used for treatment of simple partial seizures and complex partial seizures, trigeminal neuralgia, and bipolar affective disorder. Carbamazepine is absorbed erratically after oral administration because of Read more…
Here’s Dr. Basile with today’s Morning Report! Case: 60 yo female with pmh of htn, ESRD on HD presents as notification for syncope and hypotension. BP of 75/40, HR of 45. Afebrile Rectally. Bedside sono, no large pericardial effusion. Calcium Channel Blocker Toxicity Epidemiology: – In 1986: Read more…
Thanks to Dr. Martinez for today’s Morning Report! CASE: 26 y/o M recently immigrated from Haiti p/w AMS after episode of whole body shaking. Per mom, he is not responsive. He was well until this morning with no complaints except for a cough x months. He was given an Read more…
Here’s Dr. Aherne with today’s Morning Report! Carbon Monoxide Poisoning – CO: Odorless, tasteless, non-irritating – Formed by the incomplete combustion of hydrocarbons, or endogenously from the metabolism of methylene chloride (paint stripper, aerosol propellants) – Impairs oxygen delivery and peripheral utilization –> cellular hypoxia – Binds to hemoglobin Read more…
Thanks to Dr. Yeo for today’s Morning Report! Here’s the Case: A 22 year-old male patient is brought in by EMS from a nearby club for seizures. On arrival he is lethargic, hypertensive, febrile, and tachycardic. He is accompanied by his friend who reports the patient ingested multiple tablets Read more…
Here’s Dr. Willis with today’s Morning Report! Lidocaine Toxicity Epidemiology Inadvertent injection Repeated use of a therapeutic dose Unintentional administration of a toxic dose Pharmacology Amide Toxic dose: 5mg/ml and with epi 7mg/ml Blocks sodium channels (fast in, slow out mechanism) Toxicity potentiated by Med interactions (cimetidine, cipro, Read more…
Here’s Dr. Basile with today’s Morning Report! Ciguatera Poisoning – One of the most common reported forms of vertebrate fishborne poisonings in the United States (more than half of the reported cases) – Endemic to warm-water, bottom-dwelling shore reef fish living between 35 degrees south and north latitude (Indian Read more…
Thanks to Dr. Jegede for today’s Morning Report! Digoxin Toxicity What is it? Digoxin is a cardiac glycoside used in CHF refractory to other meds, atrial flutter/atrial fibrillation. Cause of digoxin toxicity? – Ingestion by children – Intentional suicidality – Dosing error in the elderly (not accounting for renal impairment) Read more…