Tox Silent Killers

We will provide clinical pearls for presentation and management of these life-threatening overdoses.

 A Medical Toxicologist’s Approach to the Overdosed Patient

A thorough toxicology history with relevant social history elements take time, but learn to start incorporating some of these questions if diagnostic uncertainty is present – i.e. ask if pets are also sick at home. Manage and stabilize patients as you would any critically ill patient with attention to ABCs and supportive care. Add in considerations of antidote, decontamination, and enhanced elimination based on suspected exposure.

 Activated Charcoal – To give or not to give?

“In the absence of satisfactorily designed clinical studies demonstrating benefit from its use, the administration of activated charcoal may be considered if a patient has ingested a potentially toxic amount of a poison up to one hour following ingestion. The potential for benefit after one hour cannot be excluded.”

 Medical Abortions & Misoprostol Toxicity

Misoprostol toxicity is very rare, however, due to more limited access to these medications people are at increased risk for harmful side effects. Normal doses of misoprostol in safe abortions are 200-1000 mcg depending on the route.

TCA Toxicity

Early correction of conduction abnormalities w/ Sodium Bicarb.

ACMT Toxicology Visual Pearls: I’ll Huff and I’ll Puff…

The abuse of which common office supply substance can result in syncope and the EKG findings...

An Approach to Household Toxicological Emergencies in the Pediatric Patient

Two percent of childhood fatalities in the United States are due to poisoning found in the home and include carbon monoxide, aspirin, lamp oils, and gasoline.

Antidotes for toxicological emergencies: a practical review

Poisoning is the second leading cause of injury-related morbidity and mortality in the United States, with more than 2.4 million toxic exposures reported each year. Recently published national consensus guidelines recommend that hospitals providing emergency care routinely stock 24 antidotes for a wide range of toxicities, including toxic-alcohol poisoning, exposure to cyanide and other industrial agents, and intentional or unintentional overdoses of prescription medications (e.g., calcium-channel blockers, β-blockers, digoxin, isoniazid).

Back to Black: A Review of Activated Charcoal

But for such a universal method of decontamination, there still remains some controversies and misconceptions amongst emergency physicians and other healthcare providers. The current debate regarding the role of AC in poison management relies on reconciling the evidence in controlled volunteer trials and heterogenous overdose patients, combined with clinical experience and expert advice.

Caustic Ingestions: hide your bleach or hide your kids

Caustics are agents like bleach or ammonia that can burn or corrode tissue due to strong acid or alkaline nature. They are more common in children (80% of cases) and are usually accidental exposures in children, but in adults, they are unfortunately intentional and often associated with psychiatric illness.

Holiday Poisonings

The holiday season is a time of celebration, but it is accompanied by an increased risk of poisoning in the home. This review covers the evaluation and management of toxicities and injuries caused by holiday-related plants and decorations.

Lipid Resuscitation Therapy

Excellent review...

Peds Poisonings

Poisoning is one of the most common medical emergencies encountered by young children and also accounts for a significant number of emergency department (ED) visits in the adolescent age group. Poisoning may be intentional or unintentional. Unintentional poisonings make up 80%-85% or more of all poisoning exposures in children. Intentional poisoning is usually seen in adolescents and young adults, and comprises about 10-15%.

Tox in The Land: Tricyclic Antidepressants

Sodium bicarb, sodium bicarb, sodium bicarb...

Tox in the Wild

Water hemlock, or Cicuta maculata, is a flowering plant from the carrot family that is native to North America. It has small white flowers and pointed green leaflets. It also has tuberous roots. Most ingestions are the result of adults who have incorrectly identified the plan as water parsnip, parsley, or ginseng. All of the plant parts are poisonous, but the tuber is the most toxic.

Toxicological Emergencies

Children under the age of 6 years account for over 70% of all poisoning cases, but only 5% of deaths. More serious cases in children may involve intentional poisoning... Adults account for most hospitalizations. Most deaths (95%) occur in adults and adolescents. Most are intentional due to illicit drug use, alcohol abuse, attempted suicide and "suicidal gesturing".

Toxicological Emergencies for the Urgent Care Physician

Several specific toxicological emergencies are most likely to be encountered in the urgent care setting. Prompt recognition of their clinical presentation, understanding the pathophysiology/natural disease progression, and initiation of treatment are critical factors in decreasing morbidity (and potential mortality) in these cases.

Toxicology Emergencies, An Issue of Emergency Medicine Clinics of North America

In this issue of Emergency Medicine Clinics, guest editors Drs. Christopher P. Holstege and Joshua D. King bring their considerable expertise to the topic of Toxicology Emergencies. The field of medical toxicology has grown dramatically over the past decade, with the emergence of new pharmaceuticals, abused substances, chemicals within the workplace, and agents of terrorism. In this issue, top experts in the field address some of the more common, controversial, or emerging areas in this challenging area.