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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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EM Quick Hits 24 Lateral Canthotomy, Cannabis Poisoning, Hyperthermia, Malignant Otitis Externa, BBB in Occlusion MI, Prone CPR

Emergency Medicine Cases

In this month's EM Quick Hits podcast: Anand Swaminathan on lateral canthotomy, Emily Austin on pediatric cannabis poisoning, Reuben Strayer on an approach to hyperthermia, Brit Long on diagnosis and management of malignant otitis externa, Jesse McLaren on ECG diagnosis of occlusion MI in patients with BBB and Peter Brindley on prone CPR.

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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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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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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. Willow tree bark extract has been used as an herbal supplement for chronic lower back pain, joint pain, osteoarthritis, sports performance, and weight loss [3].

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ToxCard: Tetanus and Strychnine – Expanding the Differential for Severe Muscle Spasm

EMDocs

Unusual strychnine poisoning and its treatment: report of eight cases. 2022 Annual Report of the National Poison Data System ® (NPDS) from America’s Poison Centers ® : 40th Annual Report. Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data. Strychnine poisoning.