EMDocs

NOVEMBER 19, 2024

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

DECEMBER 6, 2024

In the late 1990s, iron was the leading cause of poisoning deaths reported to poison control centers for children less than 6 years of age. In 1997, the Food and Drug Administration (FDA) mandated unit-dose packaging for all iron-containing products with more than 30 milligrams of elemental iron. 2 L/hr in adults. Tenenbein M.

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Poisoning Fluid Resuscitation Seizures Resuscitation 76

ALiEM

NOVEMBER 15, 2023

Although poisoning by ingestion of cyanogenic foods is much more common in tropical countries, there have been reported cases in the US [1, 3]. What are the symptoms of cyanide poisoning? How to you treat cyanide poisoning? [1, Hydroxocobalamin is the preferred antidote for cyanide poisoning. Journal of Acute Disease.

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EMDocs

JANUARY 17, 2024

The US Food and Drug Administration (FDA) approved benzonatate in 1958 for cough relief in patients ≥ 10 years. 8) Over the next 24 years, numerous peer reviewed publications on benzonatate poisoning appeared in the medical literature. (3, It is rapidly absorbed with an onset of 15-20 minutes and duration of up to 8 hours. (7)

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Poisoning Seizures Pediatrics EMS 67

ALiEM

FEBRUARY 20, 2024

Here is the patient’s EKG after administration of a 300 mEq sodium bicarbonate showing significant improvement of the cardiac sodium channel blockade as evidenced by a narrower QRS complex. Poisoning by sodium channel blocking agents. Flecainide poisoning and prolongation of elimination due to alkalinization. Crit Care Clin.

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Shock EKG/ECG Poisoning Burns 73

EMDocs

FEBRUARY 15, 2024

Diagnosis: Clinical exam findings, in combination with a thorough history help to make the diagnosis of anticholinergic plant poisoning. 7 Administer this antidote slowly via intravenous route over several minutes (5-10 minutes), as rapid administration is associated with seizures and bradycardia. Jimson weed poisoning – a case report.

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Hyperthermia / Hypothermia Poisoning Seizures COPD 90

EMDocs

AUGUST 3, 2023

IV is usually recommended due to faster onset, ease of administration, and shorter protocol duration. These local protocols vary from the labeled dosing; contacting and using your local poison center’s protocol is recommended. Extracorporeal treatment for acetaminophen poisoning: recommendations from the EXTRIP workgroup.

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Poisoning Seizures Administration Pediatrics 82

Northwestern EM Blog

MARCH 28, 2022

Clinical Findings of Methanol Poisoning CNS sedation Seizures Rapid, Deep Breathing Hypotension Ocular findings: Blindness Afferent pupillary defect Optic disk hyperemia Mydriasis Ethylene Glycol Toxicity Similarly, the toxic metabolites of ethylene glycol cause end-organ damage at levels greater than 20mg/dl.

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Poisoning Seizures Administration Pediatrics 52

EMDocs

JUNE 25, 2024

For large burns, consider albumin to lower total volume administration and improve urine output. Systemic poisoning from inhaled toxins, obstruction of the upper airway from heat injury and edema, and chemical injury to the lower respiratory system from smoke inhalation. For isolated burn injury, use balanced crystalloids like LR.

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Burns Fluid Resuscitation Resuscitation Poisoning 74

Resus Review

APRIL 6, 2015

Following the initial dose administration, if symptoms are not improving, continuing to administer up to 10 mg/kg is also recommended. Sterile phlebitis may follow administration of dantrolene, and should be infused through the largest possible vein. Dantrolene may also be useful in life-threatening cases of dinitrophenol poisoning.

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Hyperthermia / Hypothermia Poisoning Administration 52

ACEP Now

APRIL 2, 2024

Due to concerns regarding THS, the import of ackee fruit was outlawed in 1972, but since 2000 canned exports have been allowed by certain “green listed” manufacturers by the Federal Drug Administration. 8 Diagnosis and Treatment Food poisoning may result in a similar clinical manifestation as Toxic Hypoglycemic Syndrome. Clin Toxicol.

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Poisoning Administration Documentation/Coding Urgent Care 40

ALiEM

NOVEMBER 29, 2023

Food and Drug Administration for veterinary use, specifically for its muscle relaxant, sedative, and analgesic effects [1]. Consider xylazine co-intoxication if a patient presenting with an opioid toxidrome has persistent sedation despite escalating naloxone administration. Xylazine Poisoning: A Systematic Review.

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ACEP Now

MAY 8, 2023

8 A retrospective study of acetaminophen-poisoned patients found that when using a threshold of 3.5 Population-based incidence and outcome of acetaminophen poisoning by type of ingestion. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. for death. NAC should be given immediately.

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Poisoning Outcomes Administration EMS 52

Taming the SRU

SEPTEMBER 1, 2023

Shewakramani Sepsis is associated with 20-40% mortality Screening tools for detecting patient at risk for sepsis in the ED SIRS Criteria (more sensitive tool) Temp <36C (96.8F) or >38C (100.4F) HR >90 RR >20 WBC <4k or >12k (or >10% bands) qSOFA Score GCS <15 RR >22 SBP <100mmHg Overall, SIRS Criteria remains (..)

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Sepsis Fractures Documentation/Coding Administration 94

The Skeptics' Guide to EM

FEBRUARY 2, 2019

The SGEM Bottom Line was that the routine administration of supplemental oxygen in patients with suspected or confirmed acute myocardial infarction who are not hypoxic does not appear to provide a patient-oriented benefit. In acutely ill adults, this same concept is not yet as widespread and liberal administration is still common place.

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Poisoning Administration Hospitals Outcomes 52

EMDocs

APRIL 10, 2024

While not specifically reviewed in this post, check out the methemoglobinemia tox card for more information about one of the other known events that can occur with local anesthetic administration. Poisoning & Drug Overdose. Epidemiology Most common cause: inadvertent intravascular injection. Regional Anesthesia and Pain Medicine.

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Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 94

ACEP Now

JULY 8, 2023

The authors mention that “CRS were not associated with intravenous antibiotics administration, SBI [ serious bacterial illness ], or admission.” In regard to abnormally prolonged capillary refill, the positive likelihood ratio for identifying organ dysfunction within 24 hours was average, at 0.5. References Scott HF, et al.

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Pediatrics Poisoning Emergency Department Sepsis 52

ACEP Now

AUGUST 9, 2024

Antibiotics are broadly recommended for wounds that appear infected; prophylactic antibiotic administration is contested except with deep punctures, wounds contaminated with material, or those with significant tissue insult. A five-year poison center experience. Poisoning, envenomation, and trauma from marine creatures.

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Poisoning Burns Seizures Fractures 52

EMDocs

OCTOBER 10, 2024

She is concerned about food poisoning and says the groin/thigh pain feels like a prior episode of sciatica. Delay in administration of antibiotics. A delay in antibiotics administration was unfortunate but no one can say on a “more probable than not” basis that earlier treatment would have changed the outcome. Temp is 98.7

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Documentation/Coding Hospitals Sepsis Infectious Diseases 75

Cook County EM Blog

MAY 29, 2023

Early consultation with the poison center is prudent. Analysis of benzonatate overdoses among adults and children from 1969-2010 by the United States Food and Drug Administration. Food and Drug Administration (FDA). Authored by Sumeet Sandhu, DO Faculty reviewer: Jenny Lu, MD References: Sandra C. Bishop-Freeman, Erin M.

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Seizures Administration Resuscitation Poisoning 52

Advanced Emergency Nursing from AENJ

MAY 27, 2014

Even after no longer having a role in resuscitation, CO2 was advocated for accelerating clearance of carbon monoxide poisoning into the 1950s and 1960s. Davies reported in the British Medical Journal of " A simple portable apparatus for the therapeutic administration of carbon dioxide." In 1927, H.W. DAVIES, H. pp 526-528.

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ACEP Now

MARCH 6, 2024

The PATCH-Trauma trial took a critical look at TXA in major trauma in the advanced trauma systems of Australia and found a mixed result: a slightly greater number of patients were still alive six months following TXA administration, but there was no difference in survival with a good functional outcome. N Engl J Med. 2023;389(2):127-136.

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Research Airway Management Stroke Outcomes 52

ALiEM

AUGUST 16, 2023

Adverse Effects of Methylene Blue Pain at infusion site Blue discoloration of urine and serum Interferes with pulse oximetry, resulting in falsely low readings after administration. Chemically induced methemoglobinemia from aniline poisoning. Interference with laboratory studies that use light absorption. Am J Emerg Med. 2009.10.014.

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Poisoning Seizures Administration Pediatrics 52

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

She stabilized after electrolyte administration with no further episodes of TdP. Potassium chloride drip was also started. Potassium on admission was 3.5mmol/L (Ref 3.6-4.6) and magnesium 0.88 mmol/L (Ref 0.71-0.94).

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Seizures EKG/ECG EMS Stroke 104

EB Medicine

SEPTEMBER 1, 2018

Nachi: And don’t forget our peer reviewers this month, Dr. Daniel Sessions, a medical toxicologist working at the South Texas Poison Center, and our very own editor-in-chief, Dr. Andy Jagoda, who is also Chair of the Department of Emergency Medicine at Mount Sinai in New York City. Jeff: What a team! But, let’s get back to the snakes.

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Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Mind The Bleep

OCTOBER 22, 2024

At medical school, we learn that the digitalis genus of flowering plants (better known as foxgloves, with their finger or thimble-like flowers) have a useful medical application in the drug digoxin (and also as a poison if you enjoy crime fiction). To get to the modern meaning of digital, we need to visit the world of electronic technology.

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Documentation/Coding Telemedicine Urgent Care Operations 59

Taming the SRU

APRIL 10, 2023

1] OAHL has been reported after various dosages, administration routes, and lengths of opioid use. [5] 5] There are reports of OAHL occurring after oral, intranasal, intravenous, and transdermal administration, as well as one case of intra-arterial administration. Journal of Medical Toxicology. 2013;9(2):179-183.

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ACEP Now

FEBRUARY 11, 2024

Regulatory and pharmaceutical availability barriers have even resulted in changing of such medications while in treatment, incomplete usage, and alternative patterns of administration. Poison centers see nearly 1,500% increase in calls related to injected weight-loss drugs as people accidentally overdose. Diabetes Care. 2018;41:258–66.

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Seizures Fluid Resuscitation Poisoning EKG/ECG 52

Thinking Critical Care

MAY 18, 2023

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.

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Shock Research Sepsis Resuscitation 40

EB Medicine

MAY 3, 2019

Since commonly prescribed antidepressants take up to 6-8 weeks to have a clinical effect, the administration of psychotropic medications is not routinely initiated in the ED. Jeff: As always, the team approach is preferred. Alright so the last treatment to discuss is actual pharmacotherapy. More on that in a few minutes though.

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Emergency Department Psychiatric Documentation/Coding Outcomes 40

EMDocs

AUGUST 15, 2023

What are the indications for antivenom administration? Treatment of snakebite poisoning. link] Antivenom administration North American Crotalinae snakebites – UpToDate. He was admitted to the pediatrics service for further management. Questions: What are the primary clinical manifestations of crotalid envenomation?

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Poisoning Administration CDC EMS 82

RebelEM

JUNE 12, 2024

According to the 2022 Annual Report of the National Poison Data System from America’s Poison Center, CCBs and BBs account for the sixth and seventh largest number of fatalities from overdose. Rapid administration may induce nausea and emesis. 1 Recall that cardiac output is a function of both stroke volume and heart rate.

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EMDocs

AUGUST 31, 2023

Approximately 12 hours following F(ab’) 2 antivenom administration, the child is noted to have progressive swelling, firmness, tension, and pain of the right calf. Poison Control: The F(ab2)ulous Expanded Indication of Anavip | FCEP. link] Blue Ridge Poison Center, University of Virginia Health. Accessed May 7, 2022.

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Allergic Reactions Anaphylaxis Poisoning EMS 72

Taming the SRU

NOVEMBER 13, 2024

opiates or anticholinergics): Use initial nomogram and treat if initial level is above the treatment line. haffner and wright The number of psychiatric emergencies across the U.S.,

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Psychiatric Seizures Emergency Department Pediatrics 87

Intensive Blog

FEBRUARY 9, 2023

Show answer In this case, the history pointed towards mushroom poisoning. Most cases of mushroom poisoning are self-limiting episodes of gastrointestinal upset. There are many different syndromes associated with mushroom poisoning in Australia including cholinergic, hallucinogenic, glutaminergic, disulfram-like and hepatotoxic 3.

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Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

EB Medicine

AUGUST 1, 2018

Also, be aware that there are various formulations of cannabis that allow for different routes of administration. Basically, any way you can imagine, it seems like a route of administration has been explored. On the longer end, rectal cannabis administration can take up to 8 hours to reach peak plasma concentrations.

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Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EB Medicine

FEBRUARY 1, 2019

Jeff: Do consider adding on a venous or arterial carboxyhemoglobin in the right clinical scenario, as CO poisoning represents an important cause of headache you wouldn’t want to miss. Nachi: In addition to monitoring ABCs, early care involves the administration of analgesics and anti-emetics.

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Emergency Department Stroke Outcomes Ultrasounds 40