Archive for February 2015

TPR Podcast Episode #8: Pearls from NACCT

February 28, 2015, 7:06 pm

This episode of the TPR podcast will discuss pearls from some of our favorite posters at the North American Congress of Clinical Toxicology conference in New Orleans. Some of the questions we'll tackle include: * Is "sudden sniffing death syndrome" after exposure to volatile inhalants real> * What drug, sometimes abused by body builders, is an asthma medicine and also acts like an anabolic steroid? * What adverse effects can be expected after exposure to Phenibut? * Can hot pepper cream be used to treat cannabinoid hyperemesis syndrome?

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Is lipid emulsion therapy effective in calcium-channel-blocker and beta-blocker overdose?

February 28, 2015, 1:12 am


Role of intravenous lipid emulsions in the management of calcium channel blocker and β-blocker overdose: 3 years experience of a university hospital. Sebe A et al.  Postgrad Med 2015 Feb;127:119-124.


The authors of this study, from Cukurova University School of Medicine in Turkey, retrospectively reviewed patients admitted to their hospital who were treated with lipid rescue therapy (LRT) for …

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Tox on the web: 12 students hospitalized at Wesleyan College after “Molly” overdose

February 27, 2015, 1:00 am

Four students arrested at Wesleyan College after “Molly” overdoses: Last weekend a dozen students and visitors at Wesleyan University in Middletown, Connecticut were hospitalized after apparently ingesting a drug or drugs labelled as “Molly.” Two victims were in critical condition and were medevacked to Hartford Hospital, the only Level 1 Trauma Center in the region. By mid-week, these two patients …

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Excellent review of lipid rescue therapy

February 25, 2015, 6:47 pm


Intravenous Lipid Emulsion in the Emergency Department: A Systematic Review of Recent Literature. Cao D et al. J Emerg Med 2014 Dec 19 [Epub ahead of print]


This excellent comprehensive review of lipid rescue therapy (LRT) is vitiated only by the unavoidable fact that available clinical evidence  is so inconclusive. As the authors point out, published literature consists mostly …

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Sundays with SMACC: Sonowars 2014

February 22, 2015, 3:35 pm

SonoWars from Social Media and Critical Care on Vimeo.

At the SMACC Gold conference last March in Australia, an epic Sonowars contest pitted the Northern Hemisphere against the Southern Hemisphere. Representing the North were Matt Dawson and Mike Mallin from the Ultrasound Podcast. Meeting the bell for the lands down under were James Rippey and Adrian Goudie from …

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Treating severe drug-induced hyperthermia with an ice-water bath

February 20, 2015, 7:23 pm

Ice Bath★★★☆☆

Ice water submersion for rapid cooling in severe drug-induced hyperthermia. Laskowski LK et al. Clin Toxicol 2015 Mar;53:181-184.


There is still debate about the optimal method of cooling severely hyperthermic patients, such as those with core temperature > 104oF (40oC) who are exhibiting changes in mental status. Some common techniques include ice packs to the …

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Do medical toxicologists use physostigmine to treat anticholinergic toxidrome?

February 18, 2015, 2:28 pm


The Use of Physostigmine by Toxicologists in Anticholinergic Toxicity. Watkins JW et al. J Med Toxicol 2014 Dec 16 [Epub ahead of print]


Physostigmine is a carbamate that reversibly inhibits acetylcholinesterase, the enzyme that breaks down acetylcholine (ACh). By so doing, it increases the levels of ACh in synapses, serving as an antidote for drugs and agents causing …

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Hemodialysis in acute methanol poisoning: is there really good evidence?

February 16, 2015, 11:11 pm


Recommendations for the Role of Extracorporeal Treatments in the Management of Acute Methanol Poisoning: A Systematic Review and Consensus Statement. Roberts DM et al. Crit Care Med 2015 Feb;43:461-472.


The Extracorporeal Treatment in Poisoning (EXTRIP) Workgroup was established to provide evidence-based guidance on the use of hemodialysis and other methods of extracorporeal treatment in various toxic exposures. The workgroup …

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Must-read: another adverse effect associated with tramadol

February 9, 2015, 9:54 pm


Tramadol and Hypoglycemia: One More Thing to Worry About. Nelson LS, Juurlink DN. JAMA Intern Med 2015 Feb 1;175(2):194-5


Hypoglycemia associated with use of tramadol has been noted previously in scattered case reports, after both overdose and therapeutic ingestion, involving patients with and without diabetes. In this month’s issue of JAMA Internal Medicine, Fournier et al. presented a …

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