Colchicine Toxicity: A New Threat from COVID-19 Treatments
In the continued fight against COVID-19, a January 22, 2021 press release from the Montreal Heart Institute touted the potential of colchicine, citing results from the COLCORONA trial [1, 2]. We’ve learned to be especially skeptical of any study results reported only via press release before undergoing full peer-review and publication. Nevertheless, the authors claim a non-significant (p=0.08) relative risk reduction of 19% (absolute risk reduction 1.1%) in hospitalizations, mechanical ventilation, and death. Note that the pre-print of the study has still not been peer-reviewed [3]. This study comes on the heels of the much smaller GRECCO-19 study published in [+]
PEM Pearls: To Scan or Not to Scan? CT Abdomen in Children with Blunt Torso Trauma
An 18-month-old female with no past medical history is brought in by ambulance after a motor vehicle collision (MVC) at highway speed, restrained in an appropriate car seat. Mom was also brought in after delayed extrication with an obvious femur deformity. EMS reports that the patient had emesis on the scene, was fearful but calm, and has been moving all extremities. Vitals per EMS: HR 120, BP 100/60, RR 30, SpO2 99%, Temp 36.5 C Initial Exam: General: crying Neuro: Glasgow Coma Scale (GCS) of 13 (eyes shut unless talked to, crying spontaneously, moving all extremities) MSK: atraumatic chest, [+]
SplintER Series: “Pop in the Posterior Thigh”
A 20-year-old male presents with right posterior thigh pain and difficulty walking after he felt a “pop” while sprinting in a race. An ultrasound of the right posterior thigh is performed and the above image is seen on the transverse view without compression (Image 1. ST- semitendinosus; BF – bicep femoris; H – hematoma. Courtesy of Matthew Negaard, MD). [+]
SAEM Clinical Image Series: The Insidious Rash
A 60-year-old African American female with a history of hypertension presents to the emergency department for an itchy, diffuse rash. She first noticed the lesions a few years prior, and they have progressively become larger and more inflamed. The lesions have become severely pruritic over the last couple of months. Steroid creams did not appear to improve symptoms. Currently, the lesions on her arm have become painful with yellow drainage. The patient denies nausea, vomiting, and fever. [+]
2020 ACLS Guidelines on Medications for Toxicology-Related Conditions
The 2020 ACLS guidelines provide recommendations on the medication-specific management recommendations for toxicology [1]. Although the name of the guidelines emphasize they are ‘Advanced,’ these are still relatively basic toxicology recommendations and largely apply to patients in cardiac arrest or refractory shock. There are also our 2020 ACLS guideline summaries on vasopressor and non-vasopressor medications used during cardiac arrest and arrhythmia management. Benzodiazepines Flumazenil if NOT recommended in undifferentiated coma (COR3, LOE B-R) Cocaine Benzodiazepines, alpha blockers, calcium channel blockers, nitroglycerin, and/or morphine can be beneficial for hypertension, tachycardia, agitation, or chest discomfort (COR 2a, LOE B-NR) Pure beta-adrenergic blockers may [+]
2020 ACLS Guidelines on Medications for Management of Specific Arrhythmias
The 2020 ACLS guidelines provide recommendations on the medication-specific management for arrhythmias including wide-complex tachycardia, regular narrow-complex tachycardia, atrial fibrillation/flutter, and bradycardia [1]. There are also our 2020 ACLS guideline summaries on vasopressor and non-vasopressor medications used during cardiac arrest and toxicology-related conditions. Wide-complex tachycardia (WCT) Wide-complex tachycardia Medication(s) Evidence Hemodynamically stable Adenosine COR 2b, LOE B-NR Amiodarone, procainamide, or sotalol COR 2b, LOE B-R NOTE: Verapamil is harmful COR 3, LOE B-NR Polymorphic VT with long QT (torsades de points) Magnesium COR 2b, LOE C-LD Polymorphic VT without long QT Lidocaine or amiodarone COR 2b, LOE C-LD Regular [+]
2020 ACLS Guidelines on Vasopressors and Non-Vasopressors During Cardiac Arrest
The 2020 ACLS Guidelines were published in October 2020 [1]. This first of 3 blog posts will focus on vasopressor and non-vasopressor medications during cardiac arrest. Part 2 will focus on specific arrhythmia management and Part 3 will focus on toxicologic interventions. Summary There were no major updates for vasopressors and non-vasopressors used during cardiac arrest. The American Heart Association (AHA) published Highlights of the 2020 Guidelines [PDF] as a clear and concise summary. Now that the AHA is releasing focused updates in the 5-year period between guidelines (like this one on lidocaine), fewer major changes likely will be needed when [+]
Social Medicine in the Emergency Department: Not all conditions can be treated with medicines
On the day we met Jane, a woman in her 70’s with diabetes and mobility impairment, she was visiting an Emergency Department (ED) for the 50th time in the past year. Jane was experiencing homelessness and spent much of her day riding public transportation in her wheelchair. Bystanders, often concerned for her health after noticing she had an episode of incontinence, would call 911 after which Jane would be brought to the nearest ED. On the day Jane came to our ED, our multidisciplinary ED-based Social Medicine team was asked to help in her care. She was very thin, her [+]
ACMT Toxicology Visual Pearls – A Poke in the Belly
Which component of the pictured plant is the cause of gastrointestinal symptoms when ingested? Histamine Lectins Oxalates Ribosomal inhibiting proteins Saponin glycosides [+]
Caitlin Baldwin, DO
Jefferson Health - Northeast
Latest posts by Caitlin Baldwin, DO (see all)
SplintER Series: A Fateful FOOSH
A 66 year-old man presents with right anterior elbow pain, ecchymosis, and a “lump” in his right upper extremity after a ground level fall (Figure 1). What is your suspected diagnosis? What physical exam maneuver(s) can help you confirm your diagnosis? What is your initial workup in the ED? What imaging confirms the diagnosis? What is your management and disposition? Figure 1: Case Courtesy of Dr. Peter M. Martin [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Latest posts by Shuhan He, MD (see all)
- The Discharge Severity Index: Early Research on ED Readmission Risk Assessment - August 14, 2025
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- A Tale of Two Epidemics: COVID-19 and the Opioid Crisis - April 23, 2020