Is there a better way to administer IV N-acetylcysteine?

December 14, 2017, 10:26 am

★★★☆☆

Fewer adverse effects with a modified two-bag acetylcysteine protocol in paracetamol overdose. McNulty R et al. Clin Toxicol 2017 Dec 8 [Epub ahead of print]

Abstract

Current recommendations for dosing intravenous N-acetylcysteine (Acetadote) for treating acute acetaminophen (paracetamol) poisoning involves a somewhat complex three-bag protocol, using 3 direct concentrations of the antidote given over a 21-hour period. Unfortunately, …

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Case series: treating cannabinoid hyperemesis syndrome with capsaicin cream

December 5, 2017, 5:27 pm

★★★☆☆

Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series. Dezieck L et al. Clin Toxicol 2017 Sep;55:908-913.

Abstract 

Cannabis hyperemesis syndrome (CHS) is a form of cyclic vomiting characterized by:

  • chronic marijuana use
  • recurrent vomiting, and
  • lack of alternate explanation for symptoms

A striking feature is that although CHS-induced nausea and vomiting are …

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Tox Tunes #112: Chinese Rocks (Johnny Thunders & the Heartbreakers)

December 3, 2017, 11:34 pm

In a recent article discussing his favorite songs, food/travel guru Anthony Bourdain comments: “My early honeymoon period with heroin; this song made an other ill considered lifestyle option seem like a good idea.”

Bourdain probably wasn’t paying close attention to the lyrics, which describe something other than a wise personal choice:

I’m living on a Chinese Rock
All my best

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Decontamination following deliberate mass-casualty exposures

November 29, 2017, 6:00 pm

[wikipedia.org]

★★★★☆

Decontamination. Houston M, Hendrickson RG. Crit Care Clin 2005:21:653-672.

Abstract

Looking to finish some Lifelong Learning and Self-Assessment (LLSA) tests before the end of the year so I can re-certify in emergency medicine, I discovered that the subspecialty Medical Toxicology reading list modules can be used to comply with these requirements. At this time there are 3 active toxicology …

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Are ibuprofen plus acetaminophen as good as opioids in treating acute extremity pain

November 22, 2017, 3:19 pm

★★★½☆

Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial. Chang AK et al. JAMA 2017;318:1661-1667.

Abstract

As Dr. Demetrios Kyriacou points out in a must-read editorial accompanying this paper, a growing body of evidence clearly indicates that even short-term opioid use for painful injuries or procedures …

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Absolute must-watch: 60 Minutes on how pharmaceutical distributors fueled the opioid crisis

October 16, 2017, 6:02 pm

In a blockbuster investigation carried out along with the Washington Post, 60 Minutes’ Bill Whitaker looks into allegations that powerful pharmaceutical distributors helped advance the current opioid crisis by fulfilling patently suspicious orders for prescription opioids. The piece cites one example where a pharmacy in a West Virginia town with a population of several hundred ordered and received millions …

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Tox Tunes #111: Girl on LSD (Tom Petty)

October 8, 2017, 11:26 pm

Although this Tom Petty song is somewhat obscure, I’m embarrassed to say I hadn’t know about it until an article in The Cannabist after the singer’s death last week brought it to my attention. The song appeared as the B-side to “You Don’t Know How It Feels” and was scheduled to be on Petty’s 1994 album Wildflowers, …

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ACMT Position Statement: Toxicology Issues in Determining Brain Death

September 26, 2017, 9:11 pm

★★★★☆

ACMT Position Statement: Determining Brain Death in Adults After Drug Overdose. Neavyn MJ et al. J Med Toxicol 2017;13:271-273.

Full Text

The American Academy of Neurology guidelines on determining brain death in adults states that the clinician can not make such a determination unless he or she can  “[e]xclude the presence of a CNS-depressant drug effect by history, drug screen, …

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Organic psychosis and nystagmus? consider dextromethorphan toxicity

September 25, 2017, 9:46 pm

★★☆☆☆

Dextromethorphan in Cough Syrup: The Poor Man’s Psychosis. Martinak B et al. Psychopharmacol Bull 2017 Sep 15:47:59-63.

Full Text

Dextromethorphan (DXM) is found in many over-the-counter cough and cold medications. At recommended therapeutic dosage (up to 120 mg per day in divided doses) DXM is safe and has no psychiatric effects. However, DXM and its major metabolite —dextrorphan — act …

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