Management of Iron Toxicity
Iron toxicity is determined by the amount of elemental iron (Fe) ingested. Examples of Fe formulations and the amount of elemental Fe contained in each formulation are listed in the table below (adapted from 1).
SimLIFE-EM Challenge: Add to the conversation
Debriefings in medical simulation are meant to be the bow on top of the gift that is medical simulation. It is the ultimate delicious dessert, served after a grueling dinner course. All analogies aside, debriefings are meant to drive home the teaching points, to gain a deeper understanding of medical resuscitation as a group, and create mental frameworks of the approach to various patients. But this is often easier described than actually done. We here at ALiEM paired with Dr. Henry Curtis to come up with a creative way of developing debriefing skills and gain deeper understanding of mental frameworks.
Diagnose on Sight: Bilateral Leg Rash
Case: A pre-teen girl, living in central California, recently started on fluconazole, now presenting with a bilateral leg rash. What is your diagnosis? Click on the image for a larger view.
Sternoclavicular Joint Dislocations: Diagnosis and Treatment
A 16-year-old football player presents to the emergency department directly from a game. He was tackled, falling onto his right shoulder. The patient is complaining of right-sided chest pain. On exam, there is tenderness over the right sternoclavicular joint (SCJ) with a prominent medial clavicle. Range of motion is limited in the right arm. What diagnostic studies need to be performed? What treatment is warranted in the emergency department?
(more…)AIR Series: Infectious Disease, Hematology, Oncology 2014
Welcome to the first ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our readers for the reading and learning they are already doing online, we have created an Individual Interactive Instruction (III) opportunity utilizing FOAM resources for US Emergency Medicine residents. For each module, the board curates and scores a list of blogs and podcasts. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our private Google Drive database, which participating residency program directors can access to provide access.
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PV Card: Pediatric Ingestion Dose Thresholds for ED Referral
Clinical Toxicology has published guidelines for out-of-hospital management of 16 distinct overdoses and their dose thresholds, above which, pediatric patients should be referred to the Emergency Department for evaluation. Clinical Toxicology is the official journal of the American Academy of Clinical Toxicology (AACT, @AACTinfo), the American Association of Poison Control Centers (AAPCC, @AAPCC), and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT). There are two caveats to be aware of regarding these guidelines.
- They were developed between 2005 and 2007. New medications have been approved since that time and there may be more recent data available.
- As with any poisoning, dose is only one factor when determining disposition. Consideration should also be given to intent, underlying medical conditions, co-ingestion of other medications, presence of symptoms, and drug formulation.
This PV Card summarizes the pediatric ingestion dose thresholds for referral to an ED.
PV Card: Pediatric Dose Thresholds
Adapted from [1–16]
Go to ALiEM (PV) Cards for more resources.
Thanks to Zlatan Coralic, PharmD (@ZEDPharm) for his excellently detailed expert peer review and suggestions for revisions for this important card.
References
- Wax P, Erdman A, Chyka P, et al. beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(3):131-146. [PubMed]
- Caravati E, Erdman A, Christianson G, et al. Ethylene glycol exposure: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(5):327-345. [PubMed]
- Manoguerra A, Erdman A, Booze L, et al. Iron ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(6):553-570. [PubMed]
- Olson K, Erdman A, Woolf A, et al. Calcium channel blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(7):797-822. [PubMed]
- Dart R, Erdman A, Olson K, et al. Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(1):1-18. [PubMed]
- Scharman E, Erdman A, Wax P, et al. Diphenhydramine and dimenhydrinate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(3):205-223. [PubMed]
- Manoguerra A, Erdman A, Wax P, et al. Camphor Poisoning: an evidence-based practice guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(4):357-370. [PubMed]
- Caravati E, Erdman A, Scharman E, et al. Long-acting anticoagulant rodenticide poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(1):1-22. [PubMed]
- Chyka P, Erdman A, Christianson G, et al. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. [PubMed]
- Woolf A, Erdman A, Nelson L, et al. Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(3):203-233. [PubMed]
- Nelson L, Erdman A, Booze L, et al. Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(4):315-332. [PubMed]
- Chyka P, Erdman A, Manoguerra A, et al. Dextromethorphan poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(6):662-677. [PubMed]
- Scharman E, Erdman A, Cobaugh D, et al. Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(7):737-752. [PubMed]
- Cobaugh D, Erdman A, Booze L, et al. Atypical antipsychotic medication poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(8):918-942. [PubMed]
- Caravati E, Erdman A, Christianson G, et al. Elemental mercury exposure: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2008;46(1):1-21. [PubMed]
- Manoguerra A, Erdman A, Woolf A, et al. Valproic acid poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2008;46(7):661-676. [PubMed]
Intraosseous Rapid Sequence Intubation
Intravenous (IV) rapid sequence intubation (RSI) is by most considered the gold standard practice for securing an airway in the critically ill. There are, however, scenarios where it may not be possible to get rapid IV access in a timely manner (i.e. severe cutaneous burns, hemorrhagic shock, IV drug users, and/or the morbidly obese). It has been reported that intraosseous (IO) drug administration has similar pharmacokinetics to IV administration, but there have only been a handful of cases reported using the IO route for RSI. In this post we will discuss intraosseous rapid sequence intubation and if it is a feasible practice. (more…)