ACMT Toxicology Visual Pearls: Mushroom Mania

mushroom poisoning amanita muscariaAfter eating the mushroom pictured, a 15-year-old patient arrives to the emergency department agitated, diaphoretic, and hallucinating, and then acutely becomes more somnolent and less responsive. Which neurotransmitter systems are affected by the toxins contained in this mushroom?

  1. Acetylcholine and histamine
  2. Dopamine and norepinephrine
  3. Gamma-aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA)
  4. Glycine and serotonin

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2019-08-28T20:03:57-07:00

SAEM Clinical Image Series: Tea & Toast | A Case of an Abdominal Rash

Tea & Toast erythema ab igne rash


[Click for larger view]

Chief complaint: Abdominal pain, nausea, and vomiting

History of present illness: A 46 year-old female with a past history of fibromyalgia, irritable bowel disease, and chronic abdominal pain presented to the emergency department with abdominal pain, nausea, and vomiting. She reported a one-year history of similar symptoms but states that her symptoms are worse today than usual, and not improved by her home hydrocodone, medical marijuana, or heating pad use – all of which she uses daily. She has not been able to tolerate oral intake today, vomiting up her breakfast of plain toast.

The patient was observed using her home heating pad in the emergency department.

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2019-08-12T07:11:03-07:00

Accidental Hypothermia and Cardiac Arrest: Physiology, Protocol Deviations, and ECMO

accidental hypothermia and cardiac arrestAccidental hypothermia is a life threatening condition that can lead to a challenging resuscitation. The very young, old, and intoxicated patient are at high risk to developing hypothermia, even in temperate climates. The pathophysiologic changes from hypothermia make the standard ACLS approach insufficient to care for the hypothermic patient. This article will discuss the physiology of hypothermia and how you should alter your approach in the hypothermic patient, including early consideration of extracorporeal membrane oxygenation (ECMO).

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2018-12-12T04:52:45-07:00

Resuscitation of a Drowning Victim: A Review

Drowning cases peak this time of year and represent a leading cause of mortality in children. For example, drowning represents the leading cause of death in boys ages 5-14 years old, and worldwide, there are 500,000 annual deaths from drowning.1 Hypoxic injury and subsequent respiratory failure represent the primary causes of morbidity and mortality. Although providers are typically taught to be aware of possible trauma (e.g. cervical spine fracture) when evaluating a drowning case, less than 0.5% of drownings are traumatic.2 The duration of immersion, volume of aspirated fluid, and water temperature dictate clinical outcomes.1 We review the presentation, pathophysiology, and management of drowning to raise awareness about this important public health issue.
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Climate Change and Emergency Medicine: A Specialty on the Frontline

Emergency medicine (EM) is on the frontlines of climate change, which the Lancet Commission declared “the biggest global health threat of the 21st century” with “potentially catastrophic risk to human health.”1,2 Climate change is having broad and profound negative impacts on the health of our patients, especially for the vulnerable populations. It is also affecting our healthcare systems and mandating the creation of climate-resilient emergency departments (ED) with robust disaster preparedness. EM needs to engage climate change advocacy efforts for 2 key reasons. It has a profound impact on our specialty, and it is built into the moral fiber of our practice. As this threat continues to grow, EM is perfectly situated to lead the charge.
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2019-02-19T18:37:47-07:00