May 17, 2013, 9:43 pm





Critical Care Management of Verapamil and Diltiazem Overdose with a Focus on Vasopressors: A 25-Year Experience at a Single Center. Levine M et al. Ann Emerg Med 2013 May 1 {Epub ahead of print]
Abstract
This uncommonly interesting and thought-provoking study comes from the Department of Medical Toxicology at Banner Good Samaritan Medical Center in Phoenix. The authors note that …
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January 5, 2013, 4:42 pm
Forbes has posted a detailed and well-researched article (set to appear in the magazine’s January 21, 2013 issue) reviewing the amazing history of Press Ganey Associates, and pointing out statistical problems — not to mention potential dangers — inherent in patient satisfaction surveys.
As reporter Kai Falkenberg notes, the Press Ganey company was started in 1985 by 2 academics from …
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December 16, 2012, 11:46 pm

A must-read article in the Wall Street Journal this weekend focuses on Dr. Russell Portenoy, a New York City pain specialist who two decades ago was instrumental in the drive to expand use of opioid analgesics to treat chronic pain. (Unfortunately, the article is behind the WSJ firewall and requires subscription.)
The Journal notes that today, prescription opioids …
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October 19, 2012, 11:58 am






The Narcotic Bowel Syndrome: Clinical Features, Pathophysiology and Management. Grunkemeier DMS et al. Clin Gastrointerol Hepatol 2007 Oct;5:1126-1139.
Full text
TPR has discussed in the past how the important diagnosis of narcotic bowel syndrome (NBS) is often missed, causing patients to undergo unnecessary procedures (CT scans, laparotomies, etc) and endure escalating gastrointestinal pain and distress. These patients also experience considerable …
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August 29, 2012, 7:02 pm






Fatalities Temporally Associated with the Ingestion of Ibogaine. Alper KR et al. J Forensic Sci 2012 Mar;57:398-412.
Abstract
Ibogaine is a psychoactive alkaloid found in the bark of the root of the iboga plant (Tabernanthe iboga), a shrub that grows in the rain forests of western Central Africa. The plant is an important adjunct to Bwiti religious ceremonies …
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July 10, 2012, 9:48 pm





Management of Opioid Analgesic Overdose. Boyer EW. N Engl J Med 2012 Jul 12;367:146-55.
No abstract available online
This is an excellent review of issues involved in managing opioid overdose, that has the distinct advantage of offering strong opinions on some controversial topics. While I’m not sure that I agree with everything Dr. Boyer advocates in this article, I …
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July 3, 2012, 1:18 am






Multiple MDMA (Ecstasy) Overdoses at a Rave Event: A Case Series. Armenian P et al. J Intensive Care Med 2012 May 28 [Epub ahead of print]
Abstract
This remarkable case series describes 12 patients with severe MDMA (ecstasy) toxicity brought to San Francisco area hospitals from a single “rave” party at the Cow Palace in May 2010. Two of the …
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February 25, 2012, 3:20 pm





Antidotes for toxicological emergencies: A practical review. Marraffa JM et al. Am J Health-Syst Pharm 2012 Feb 1;69:199-212.
Abstract
Although aimed primarily at hospital pharmacists, this superb review of the major toxicological antidotes would also be helpful reading for emergency physicians and nurses. The authors provide focused intelligent sections on toxic-alcohol poisoning, antidotes for calcium-channel blocker and β-blocker overdose, the cyanide …
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February 11, 2012, 5:05 pm






Death Following Recreational Use of Designer Drug “Bath Salts” Containing 3,4,-Methylenedioxypyrovalerone (MDPV). Murray BL et al. J Med Toxicol 2012 Jan 20 [Epub ahead of print}
Abstract
This very interesting case report describes a 40-year-old male who developed excited delirium syndrome after snorting and injecting a “bath salt” product later found to contain the synthetic cathinone MDPV, as …
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