For those who could not make it to VMR, we went over a truly sick calcium channel blocker overdose case. If not, here’s a quick rundown, and a link to the slides. Briefly, the case was a 17-year-old female who reportedly overdosed on 60 m…
Case: 37-year-old M presenting with obtundation and possible seizure-like activity after a large overdose of sustained-release bupropion (Wellbutrin XL), gabapentin, and other unknown medications. Given the severity of this patient’s…
Activated Charcoal: A Quick Summary of a Summary inspired by Dr. Ahra Cho With all the Tox VMRs going on, we often turn to activated charcoal as a method of decontamination, but we don’t often talk about how exactly activated charcoal…
Case Summary: 22 y/o M no pmh p/w painless jaundice x 5 days in the setting of recent febrile illness 1 week prior and taking Tylenol 1g q6h for several days. Physical exam was positive for jaundice, otherwise normal. Notable lab findings i…
What do smack, dragon, horse, salt, brown sugar, china white, and black pearl have in common? That’s right… they are all nicknames for heroin. We all know that Naloxone (Narcan) is a useful antidote in overdose, however appropriate dosing a…
ED physicians need to be comfortable with the various modalities of opioid substitution therapy (OST) and their associated complications. We are all familiar with the patient who has missed a daily dose of methadone on the way to booking a…
At the request of department leadership, we will be revisiting methods of gastric decontamination for today’s pearl. Two methods in particular. Ipecac-induced emesis and gastric lavage are two procedures that we read about in medical…
Remember your chronic cannabinoid user that comes in with hyperemesis. They have Cannabinoid hyperemesis syndrome (CHS): cyclic abdominal pain, nausea, and vomiting in the setting of chronic cannabis use. You try every anti-emetic in you…
You are called to triage to assess a man for shortness of breath. Per EMS, this is a 46 year old male with a history of substance abuse and HTN, found by his wife this afternoon, overdosed on Heroin and barely breathing. EMS arrived on scen…
In recent years, a number of states have decriminalized marijuana for medical use, and some have even decriminalized recreational use. This trend is likely to continue. Much of this marijuana – particularly when used recreationally – is con…
Welcome to Digoxin Day, Part 2! Like all sequels, this is sure to be even better than the original. Cardiac Physiology of Digoxin: Cardiac glycosides increase parasympathetic tone by acting on the vagus nerve. They also depress myoca…
Digoxin is a cardiac glycoside, and it has a narrow therapeutic window (0.5-2 ng/ml). Due to its sub-milligram dosing, its dependence on renal clearance, and its interactions with many other drugs, digoxin toxicity is a real concern for pat…
To call opioid use in the US a “problem” is a gross understatement, and most of us in Emergency Medicine appreciate this. You may believe that if you only prescribe a small number of pills to an opioid-naïve patient who is truly in pain, yo…
*Thanks to Dr. Clark Owyang for following this “case” with me! On February 13, Kim Jong-un, son of Kim Jong-il and half-brother of current North Korean leader Kim Jong-un, was poisoned at Kuala Lumpur airport in Malaysia….
Methylene blue (MB) is a heterocyclic aromatic compound, and a basic thiazine dye. We all know that it is used to treat methemoglobinemia. MB is an oxidizing agent, which becomes a reducing agent when NADPH reduces it to leukomethylene blue…
