ACMT Toxicology Visual Pearls: Blue Urine
A bedside urine test for a pesticide is positive as shown in the photo. What pesticide is being detected?
- Chlorpyrifos
- Diquat
- Glyphosate
- Paraquat
Case of a Lethargic Child: Developing a Differential Diagnosis
A 2-year-old previously healthy boy presents to the emergency department (ED) acting sleepier than usual. Yesterday, he was in his usual state of health, but this morning he didn’t wake up at his usual time of 6 am. When his father went to his room at 7 am, the child was lying in bed. He opened his eyes to look at his father, but did not get out of bed. The mother and father deny any trauma, fever, or seizure activity.
ALiEMU Capsules Module 11: Acute Agitation
We are proud to present Capsules Module 11: Acute Agitation, now published on ALiEMU. We present a summary of the module with key points from a stellar module by PharmDs Jenny Koehl, Kyle DeWitt, Gabrielle Procopio, and Zlatan Coralic. When you’re finished, head over to the Capsules page for even more practical pharmacology for the EM provider.
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Reversing Anticoagulation to Administer Systemic Fibrinolytics for Ischemic Stroke: Pump the Brakes
Care of acute ischemic stroke patients is a complex and time-sensitive team effort. There is a potentially dangerous trend in the medical literature over the past few years that seems to be increasing as of late: reversing anticoagulation in order to administer systemic thrombolytic therapy. The purpose of this post is to highlight the available literature on this topic, specifically related to the direct acting oral anticoagulants (DOACs), and discuss why we should not support this practice (at least as of today).
4 New Podcasts on the Opioid Initiative | ACEP E-QUAL Series
The American College of Emergency Physicians (ACEP) features 3 quality improvement targets within their Emergency Quality Network (E-QUAL) initiative: sepsis, imaging, and chest pain. Most recently, they added a fourth new focus on the opioid epidemic. This opioid initiative covers best-practice approaches and strategies for managing opioid-related complications. In collaboration with ACEP E-QUAL, we have remixed and distilled 5 of their webinars into 4 podcasts.
ACMT Toxicology Visual Pearls: Toxic Mouth Pain
A middle-aged Asian female presents to the emergency department complaining of 2-3 days of mouth pain. She has chewed betel nut for a number of years. Which of the following is true regarding her presentation and management?
- Debridement should be avoided.
- Metronidazole is contraindicated due to the potential of a disulfiram-like reaction.
- Oral secretagogues should be used due to the anticholinergic effects.
- The patient is at increased risk of oral cancer.
Replace dolutegravir (Tivicay) with raltegravir (Isentress) for post-exposure prophylaxis
Post-exposure prophylaxis (PEP) of patients who may have been exposed to HIV includes a combination HIV nucleoside analog reverse transcriptase inhibitor emtricitabine/tenofovir (Truvada) plus an integrase inhibitor. The CDC initially recommended the integrase inhibitor dolutegravir (Tivicay). However on May 18, 2018, the CDC placed an alert about the neural tube defect risk with dolutegravir.1 How does this change our ED practice?
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