Rant: ultrasound visualization of pills in the stomach will never make sense

May 25, 2016, 4:46 pm

Konstantin Shevtsov/shutterstock.com

Konstantin Shevtsov/shutterstock.com

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Accuracy of Trans-Abdominal Ultrasound in a Simulated Massive Acute Overdose. Sullivan S et al.  Am J Emerg Med 2016 Apr 23 [Epub ahead of print]

Abstract

As soon as emergency portable bedside ultrasound became feasible approximately three decades ago, toxicologists wondered if it would be a useful modality for visualizing pills in the stomach of overdose patients.

The …

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5-MAPB: a novel psychoactive benzofuran

May 24, 2016, 1:23 pm

5_MAPB

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Acute Toxicity Associated With the Recreational Use of the Novel Psychoactive Benzofuran N-methyl-5-(2 aminopropyl)benzofuran. Sofer KE et al. Ann Emerg Med 2016 Apr 26 [Epub ahead of print]

Abstract

5-MAPB is a psychoactive benzofuran with a structure and effects similar to those of MDMA (Ecstasy.) Although there has been scant investigation of its pharmacologic and toxic effects, animal …

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Absolute must-read: LA Times on the myth of OxyContin’s 12-hour analgesic effect

May 7, 2016, 9:15 pm

A-bottle-of-OxyContin-bra-007

Quick: how long does a dose of Oxycontin provide pain relief?

Most clinicians would probably say 12 hours, since the drug was extensively marketed as a twice-daily opioid analgesic and the manufacturer — Purdue Pharma — cited this originally unique convenience factor as justifying its high cost, which could exceed $630 a bottle.

In an explosive and masterfully written i…

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Cardiac effects of loperamide overdose

April 29, 2016, 5:59 pm

Loperamide★★★☆☆

Not your regular high: cardiac dysrhythmias caused by loperamide. Wightman RS et al. Clin Toxicol 2016 Jun;54:454-458

Abstract

Loperamide is an over-the-counter anti-diarrhea medication that is available without prescription under a variety of brand names including Imodium. In therapeutic doses, loperamide acts as a peripheral mu-opioid receptor agonist but doesn’t cross the blood-brain barrier (BBB). However, in massive …

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Bedside echocardiography findings in carbon monoxide-poisoned patients

April 28, 2016, 9:34 pm

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Incidence and patterns of cardiomyopathy in carbon monoxide-poisoned patients with myocardial injury. Cha YS et al. Clin Toxicol 2016 Apr 11 [Epub ahead of print]

Abstract

At last year’s Social Media and Critical Care (SMACC) conference in Chicago, I gave a talk remarking on how bedside ultrasound imaging in critically ill toxicology patients is underused and little studied. I suggested …

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Metronidazole-induced cerebellar syndrome

April 15, 2016, 3:45 pm

Metronidazole_encephalopathy★★★½☆

Metronidazole-Associated Encephalopathy. Farmakiotis D, Zeluff B. N Engl J Med 2016 Apr 14;374:1465

Full Text           

Exposure to metronidazole (Flagyl) can precipitate a subacute cerebellar syndrome, typically manifested with dysarthria and ataxia, with or without cognitive impairment. This adverse effect is uncommon and little-appreciated. Although usually associated with prolonged exposure to the antibiotic for treatment of conditions such as abscesses of …

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Vasculitis after snorting cocaine contaminated with levamisole

April 7, 2016, 2:28 pm

Lawrence et al. Allergy Rhinol (Providence) 2014 Copyright policy — open-access

Lawrence et al. Allergy Rhinol (Providence) 2014
Copyright policy — open-access

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Cocaine-induced ecchymotic rash. Voore NK. Cleve Clin J Med 2016 Apr;3:252-253.

Full Text

Since at least 2010, a large percentage of cocaine samples seized in the United States has contained levamisole, a veterinary anti-worm medication.

Levamisole had previously used in humans as an anti-helminthic and also in some …

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Cocaine-associated cardiotoxicity: a systematic review yields no answers

April 6, 2016, 3:26 pm

Christopher Siesarchik/shutterstock.com

Christopher Siesarchik/shutterstock.com

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Treatment of cocaine cardiovascular toxicity: a systematic review. Richards JR et al. Clin Toxicol 2016 Feb 26 [Epub ahead of print]

Abstract

This paper is the most frustrating thing I’ve read since I force marched my way through the “Oxen of the Sun” chapter of James Joyce’s Ulysses. I must say that, despite its difficulties, …

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Is ketamine safe and effective in excited delirium?

March 29, 2016, 12:43 pm

Zerbor/shutterstock.com

Zerbor/shutterstock.com

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Ketamine as Rescue Treatment for Difficult-to-Sedate Severe Acute Behavioral Disturbance in the Emergency Department. Isbister GK et al. Ann Emerg Med 2016 Feb 10 [Epub ahead of print]

Abstract

Rapidly sedating a toxicology patient who presents with excited delirium is a critical — yet often difficult — action. These patients are typically difficult to control and resistant to sedation …

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