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2023 AHA Update on Management Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning

EMDocs

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. Opioid overdose remains the leading cause of cardiac arrest due to poisoning in North America. COR 2a, LOE B-NR.

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Dantrolene for Malignant Hyperthermia

Resus Review

Malignant hyperthermia is a life-threatening reaction to volatile anesthetics and the neuromuscular blocking agent succinylcholine. Dantrolene acts at the ryanodine receptor blocking the release of calcium from the sarcoplasmic reticulum, and reducing the intracellular calcium, thereby countering the effects of the malignant hyperthermia.

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ACMT Toxicology Visual Pearl: The Bark with Some Bite

ALiEM

How can people become poisoned with willow bark? With severe toxicity, patients can have altered mental status, seizures, hyperthermia, and pulmonary edema. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. Tinnitus, nausea, vomiting, and abdominal pain are common. 2017;177(5):674-683.

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ToxCard: Anticholinergic Plant Toxicity

EMDocs

3-6 Clinical Presentation: Symptoms include altered mental status, tachycardia, hyperthermia, urinary retention, mydriasis, blurred vision, dry skin, hallucinations. 3-6 Clinical Presentation: Symptoms include altered mental status, tachycardia, hyperthermia, urinary retention, mydriasis, blurred vision, dry skin, hallucinations.

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ToxCard: Second Generation Antipsychotic Overdose

EMDocs

of exposures reported to poison control centers in 2021 were related to antipsychotics or sedative-hypnotics with the majority of those exposures occurring in patients 20 years of age or older. Consult a medical toxicologist or regional poison control (at 1-800-222-1222 in the United States). Front Psychiatry. Clinical Toxicol.

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emDOCs Podcast – Episode 103: Thermal Burn Injury

EMDocs

For large burns, consider albumin to lower total volume administration and improve urine output. Severely burned patients have impaired thermoregulation and are at risk of hypothermia. If the patient is altered after smoke exposure in an enclosed spaced, consider carbon monoxide or cyanide poisoning. Avoid normal saline.

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Etomidate: a perspective on a current controversy.

Thinking Critical Care

In the UK the Committee for Safety of Medicines merely drew attention to potential hazards of etomidate administration. Should regulatory authorities have done more to prevent the continued use of this poison? There are post scriptums to this story. An Inspector called from time to time to ensure our work was humane. [11] 311:1137-43.

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