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Ep 180 Acetaminophen Poisoning – Pitfalls in Assessment and Management

Emergency Medicine Cases

In this main episode podcast we explore a dozen pitfalls in the assessment and management of acetaminophen poisoning. Which patients are the ones that we are most likely to miss and have poor outcomes? What are indications for fomepizole and dialysis after acetaminophen poisoning? and many more.

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When Do Pediatric Ventriculoperitoneal Shunts Fail?

ACEP Now

Dr. Cantor is the emeritus medical director for the Central New York Poison Control Center and professor of emergency medicine and pediatrics in Syracuse, N.Y. Outcome analysis of ventriculoperitoneal shunt surgery in pediatric hydrocephalus. References Ghritlaharey RK, Budhwani KS, Shrivastava DK, Srivastava J. J Neurosurg Pediatr.

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Chemical Burns

Mind The Bleep

National Poisons Information Service (0344 892 0111) and TOXBASE have useful information on special chemicals and are accessible 24/7. Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. This should be done continuously for at least 20-30 minutes.

Burns 52
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Diarrhea

Pediatric Emergency Playbook

Traditional Approach: Secretory -- poisoned mucosal villi -- "the sieve" Cytotoxic -- destroyed mucosal villi -- "the shred" Osmotic -- malabsorption -- "the pull" Inflammatory -- edema, motility -- "the push" Lots of overlap, difficult to apply to clinical signs and symptoms. Pediatrics. 1999 Feb;103(2):E18 Lee JY et al.

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GCS less than 9, Intubate or Not?

Emergency Medicine Education

The watch-and-wait approach, involving close monitoring for individuals with traditional GCS scores <9 and suspected acute poisoning, demonstrated positive outcomes. In November 2023, JAMA published an article on noninvasive airway management among patients with depressed consciousness. Link to article

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SGEM#243: Enough is Enough (O2 Saturation of 94-96%)

The Skeptics' Guide to EM

While supplemental oxygen is undoubtedly beneficial for patients acutely desaturating, in respiratory distress, or suffering from carbon monoxide poisoning just to name a few, there is widespread “indication creep” for this therapy. This study expands upon that investigation to patients with other conditions as well.

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Methanol poisoning

Don't Forget the Bubbles

You smell the faint odour of alcohol on the child’s breath A quick mental note: methanol poisoning? Methanol poisoning is rare, but when it strikes, its delayed onset and devastating effects make it a condition we must be ready to recognise and manage. Paracelsus was right, “The dose makes the poison.” What is Methanol?