Archive for October 2013

Patient woke up just as docs about to remove her organs

October 31, 2013, 2:46 pm

My recent column in Emergency Medicine News, about the patient in a Syracuse, NY hospital who woke up in the operating room just before her organs were about to be harvested for donation, is now online.  The read it, click here.…

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Fatal attraction: ingested magnets can cause GI perforation or worse

October 30, 2013, 9:20 pm




Rare-Earth Magnet Ingestion-Related Injuries Among Children, 2000-2012. Roo ACD et al. Clin Pediatr 2013 Nov;52:1006-1013.


 In November 2011, the Consumer Product Safety Commission (CPSC) issued a warning about the dangers presented by high-powered rare-earth magnets that were being sold as desk toys or stress relievers.

These products — marketed under the trade name “Buckyballs”, among others — consisted

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Tests fail to find traces of krokodil

October 28, 2013, 6:17 pm

Tests fail to identify krokodil: The Chicago Tribune reports that recent tests of drug samples have failed to find “krokodil“, the so-called “flesh-eating drug” that causes horrific soft tissue injuries when injected. “Krokodil” originated from — and has largely been confined to Russia — where desperate addicts faced with a shortage of heroin and corresponding high prices made …

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Tox Tunes #75: Cold Blue Steel and Sweet Fire (Joni Mitchell)

October 27, 2013, 3:47 pm

As Sheila Weller points out in her book Girls Like Us, Joni Mitchell wrote “Cold Blue Steel and Sweet Fire” as she was getting over her relationship with James Taylor and coming to terms with his drug use. (It’s not a coincidence that one of Taylor’s biggest hits — also dealing with his heroin addiction — was “Fire

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Pearl: falsely normalized anion gap in salicylate overdose

October 26, 2013, 5:54 pm


Negative anion gap metabolic acidosis in salicylate overdose — a zebra! Kaul V et al. Am J Emerg Med

No abstract available

Salicylate overdose typically presents with a high-anion-gap metabolic acidosis. There are several reasons for this:

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Genital Injury and Toxicology

October 25, 2013, 12:22 am


Self-inflicted Testicular Amputation in First Lysergic Acid Diethylamide Use. Blacha C. et al.  J Addict Med 2013;7:83.4.


This striking case report describes a 32-year-old man without previous mental health problems who amputated both his testicles after possibly using lysergic acid diethylamide (LSD) for the first time, along with alcohol. According to the paper:

Mr. A. was admitted to the

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Review: managing the bleeding patient on one of the new anticoagulants

October 24, 2013, 1:58 am


Management of bleeding and reversal strategies for oral anticoagulants: Clinical practice considerations. Nutescu EA et al. Am J Health-Syst Pharm 2013 Nov 1;70:1914-29.


This long review article —presenting consensus recommendations of an “expert” panel — is seriously hampered by the fact that there are not many clinical, or even laboratory, studies of reversing the anticoagulation effects of dabigatran (Pradaxa), …

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Two fatal cases of aphrodisiac overdose

October 19, 2013, 6:04 pm




Case Study: Two Fatal Case Reports of Acute Yohimbine Intoxication. Anderson C et al.  J Anal Toxicol 2013;37:611-614.


This paper reports 2 medical examiner cases in which death was attributed to yohimbine overdose on the basis of extremely high post-mortem levels and no other apparent contributing factor. Although the article will be of most interest to forensic pathologists …

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Pearl: estimating renal function in patients on dabigatran (Pradaxa)

October 18, 2013, 6:24 pm


I was reminded of an key point about dabigatran (Pradaxa) while reading a recent article about estimating renal function in patients on new oral anticoagulants. The RE-LY trial comparing dabigatran versus warfarin in patients with atrial fibrillation excluded patients with creatinine clearance (CrCl)  <  30 ml/min. (Recommendations in the current package insert are somewhat more liberal.) This is important, since …

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