PEM Pearls: Metered-Dose Inhaler versus Nebulizer

metered-dose inhaler

An 8-year-old is brought in by her parents with shortness of breath and wheezing. She’s been receiving her “rescue inhaler” at home and continues to have symptoms. You examine her and find that she has normal oxygen saturation, mild tachypnea and retractions, and diffuse wheezes. You think that she’s experiencing an acute asthma exacerbation. Given the current pandemic, and a recent report that administering nebulizer treatments to COVID-19 positive patients was correlated with transmission of COVID-19 to healthcare workers [1], what is the best way to treat the patient?

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By |2020-07-01T07:58:37-07:00Jun 24, 2020|PEM Pearls, Tox & Medications|

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

huffing

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

  1. Dust Off (difluoroethane)
  2. Elmer’s glue (polyvinyl acetate)
  3. Hand sanitizer (ethyl alcohol)
  4. Rubber cement (heptane, isopropyl alcohol)

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By |2020-06-27T11:54:06-07:00Jun 22, 2020|ACMT Visual Pearls, Tox & Medications|

Hydroxychloroquine Toxicity

hydroxychloroquine toxicityAs the COVID-19 pandemic continues to unravel, the role of hydroxychloroquine (HCQ) in the treatment of patients with this disease has been a major focus of discussion on the news and social media. Despite the lack of good data supporting its use in the clinical setting, there have been numerous reports of individual consumption of HCQ resulting in accidental overdose and even death. It is therefore important to recognize and manage patients who may present with HCQ toxicity.

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By |2020-06-16T09:03:04-07:00Jun 17, 2020|COVID19, Tox & Medications|

Trick of the Trade: Sodium Bicarbonate for Acute Symptomatic Hyponatremia

sodium bicarbonate

A 25-year-old woman is brought into the emergency department by friends due to “acting weird.” She was at a rave and is reported to have consumed alcohol, marijuana, and ecstasy. On exam, she is afebrile, tachycardic, normotensive, and breathing comfortably on room air. She is lethargic, mumbling incomprehensibly, and does not follow commands. Her glucose is 115 mg/dL, her pregnancy test is negative, her EKG reveals sinus tachycardia, her ethanol level is 30 mg/dL, and a stat CT head is negative. Her chemistry panel reveals a sodium level of 114 mEq/L. You order a 100 mL 3% sodium chloride bolus, but it may take 30 minutes to arrive from the central pharmacy. At this point, the nurse informs you that the patient is seizing.

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