Whipped Cream Charger Abuse: The Toxicologist Mindset

The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System.

Case: A 39-year-old man, with no significant past medical history, was brought to the emergency department by family members, over three consecutive days, for anxiety, confusion, and ataxia. In the first two visits, his laboratory work-up, including complete blood cell count, chemistry panel, liver function tests, urine drug screen, and non-contrast head CT, were unremarkable. On his third visit, he was profoundly encephalopathic with confusion and poor concentration. He had bilateral lower extremity weakness and ataxia. He was admitted to the neurology service for further work up. Additional history revealed that hundreds of empty canisters of whipped cream chargers were found in his house.

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By Kathy Vo, MD|2016-11-11T19:47:20-08:00Oct 17, 2016|Tox & Medications|

ALiEMU CAPSULES Module 7: Emergency Thyroid Disorders

We are proud to present CAPSULES module 7: Emergency Thyroid Disorders, now published on ALiEMU. Here is a summary of the key points from this outstanding module by Drs. Craig Cocchio and Colleen Martin.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2019-02-19T18:24:36-08:00Oct 10, 2016|Capsules, Endocrine-Metabolic, Tox & Medications|

AIR-Pro: Toxicology (Part 1)

Welcome to the Toxicology (Part 1) AIR-Pro Module. Below we have listed our selection of the 10 highest quality blog posts related to 5 advanced level questions on toxicology topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:

Flumazenil in benzodiazepine overdose
Acetaminophen – drawing and timing of levels
Opioid overdoses
Acetaminophen toxicity related to liver transplant
Salicylates and hemodialysis

In this module, we have 6 AIR-Pro’s and 4 Honorable Mentions. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net and FOAMSearcher.We have a brand new chief resident team and want to thank the out-going team for all of their support!

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By Fareen Zaver, MD|2017-01-20T12:32:53-08:00Sep 26, 2016|Approved Instructional Resources PRO (AIR-Pro Series), Tox & Medications|

‘Treat and Release’ after Naloxone – What is the Risk of Death?

Often in the prehospital setting, naloxone is administered by EMS (or possibly a bystander) to reverse respiratory and CNS depression from presumed opioid overdose. The patient then wakes up, and not uncommonly, refuses transport to the hospital. The question is: Is it safe to ‘treat and release?’ Or, rather, what is the risk of death associated with this practice.

Last updated: January 2, 2019

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2020-04-20T19:47:14-07:00Aug 24, 2016|Podcasts, Tox & Medications|

Cardiotoxicity from Loperamide Overdose: The Toxicologist Mindset

The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System.

A 21-year-old man with history of opiate abuse was brought in by ambulance after 2 episodes of syncope and 1 episode of self-limited ventricular fibrillation. On initial presentation, the patient was found altered and unresponsive. His mental status improved after the administration of naloxone. On further history, the patient reported ingesting 50 -100 tablets of loperamide (2 mg) daily. A rhythm strip was obtained.

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By Kai Li, MD|2017-03-05T14:18:45-08:00Aug 8, 2016|Tox & Medications|

Bark Scorpion Sting: Indications for Anascorp and dosing controversies

The genus Centruroides, also known as the Bark Scorpion, is found throughout the southwestern United States and northern Mexico. Many emergency medicine practitioners in the Southwest are exceptionally familiar with the treatment of envenomation from Centruroides as a quarter million are reported annually^1,2. Although typically mild envenomations occur in adults, children and the elderly are at increased risk for severe complications³. The toxic syndrome consists of a sympathetic and parasympathetic storm that can result in myocardial damage, involuntary jerking, wandering eye movements, and most threatening – loss of airway.

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By Michael Sisson PharmD|2018-01-30T02:59:08-08:00Jul 27, 2016|Environmental, Expert Peer Reviewed (Clinical), Tox & Medications|

5 Tips for Managing Pain in Older Adults

Pain is the most common reason people seek care in Emergency Departments. In addition to diagnosing the cause of the pain, a major goal of emergency physicians (EPs) is to relieve pain. However, medications that treat pain can have their own set of problems and side effects. The risks of treatment are particularly pronounced in older adults, who are often more sensitive to the sedating effects of medications, and are more prone to side effects such as renal failure. EPs frequently have to find the balance between controlling pain and preventing side effects. Untreated pain has large personal, emotional, and financial costs, and more effective, multi-modal pain management can help reduce the burden that acute and chronic pain place on patients.¹ There is evidence that older adults are less likely to receive pain medication in the ED.^2,3 The first step to improving, is being aware of the potential tendency to under-treat pain in older adults. Here are 5 tips to help you effectively manage pain in older adults on your next shift.

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By Christina Shenvi, MD, PhD, MBA|2016-12-16T15:29:06-08:00May 25, 2016|CME, Geriatrics, Tox & Medications|

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