Up to date review and in depth analysis of Emergency Medicine toxicology topics
The Case 34 year-old woman with past medical history of postpartum cardiomyopathy (EF 15%) with AICD, mechanical mitral valve replacement, and depression was brought in by EMS for non-accidental ingestion of bupropion, furosemide, and warfarin. The dosage, number of tablets, and timing of ingestion was unknown. The patient was lethargic and Read more…
Opioids are a mainstay of ED therapy and also a common culprit in iatrogenic medication errors. In most cases involving such errors, the patient’s presenting medical complaint was not life-threatening; however, the opioid administration led to a near-fatal event. These errors are generally predictable and avoidable. The Study: “Preventing Iatrogenic Overdose: Read more…
Activated Charcoal (AC): To give or not to give? By Dr. Ferrari (Reviewed by deSouza) History of Activated Charcoal 1831 French Academy of Medicine: Tovery takes AC with a lethal dose of strychnine without symptoms 1960s, review article in Journal of Pediatrics, popularizes its use Standard at this time was Read more…
A 70 y/o woman with CHF, irregular heart beat and DM presents with malaise, nausea, vomiting and diarrhea x 1 week. On exam, she appears weak and confused. Vitals are normal except mild bradycardia. FS is 100. EKG is shown. Read more…
A 29-year-old male comes to your ED complaining of pressure-like left sided chest pain that started an hour after he smoked marijuana. He has never felt anything like this before. He has no medical problems, surgeries, medications, allergies, and has no family history of heart disease. He does not smoke cigarettes, Read more…
A 52 y/o woman w/ fibromyalgia is found alone in her room in a confused state by her maid. She recently lost all of her retirement money and constantly “Blames Obama.” She is then rushed to the emergency room where she is found to be disoriented x2 (oriented to the Read more…
This drug causes this rash… This drug caused an outbreak of agranulocytosis among healthy 20 year olds… The drug is widely available in countries with a large livestock industry (for use as antihelminthic)… Brief Discussion: This topic seemed interesting to investigate and Read more…
Cardioactive Steroids The cardioactive steroid (CAS) that is most likely to be encountered is digoxin, which is still used clinically, but CAS are also present in animals such as the Bufo toad and in many plants, including foxglove, oleander, lily of the valley, and red squill. The effects of acute Read more…
Calcium Channel Antagonists In contrast to β-adrenergic antagonists (BB), most patients with significant calcium channel antagonist (CCB) ingestions exhibit toxicity. Initially asymptomatic patients should be expected to develop rapid deterioration and must be monitored closely. Patients commonly present in cardiogenic shock and their ECG can show sinus bradycardia, AV conduction Read more…
Beta-Adrenergic Antagonists Although beta blocker (BB) overdoses are often asymptomatic in healthy patients, severe toxicity can occur. The beta blocker poisoned patient will be hypotensive and bradycardic, and the ECG may show sinus bradycardia, an AV node block, sinus pauses, or, in severe cases, asystole. Acute congestive heart failure may Read more…