Archive for the ‘Best of TPR’ Category

The first 100 “Tox Tunes”

August 30, 2015, 9:15 pm

On January 3, 2010, TPR launched “Tox Tunes,” a series of clips of songs about drug, toxins, and poisons starting with Keith Richards’ version of Reverent Gary Davis’s “Cocaine Blues.” Last week, we featured our one-hundredth tune, Amy Winehouse’s classic — and tragically ironic — song “Rehab.” To celebrate the 100-tunes milestone, we are listing all …

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Early metabolic acidosis and coma in massive acetaminophen overdose

August 7, 2015, 1:33 pm


Coma and Severe Acidosis: Remember to Consider Acetaminophen. Villano JH et al. J Med Toxicol 2015 July 8 [Epub ahead of print]


This paper, from UC-San Diego, contains an excellent case discussion that makes numerous important points about a patient who presents with decreased mental status and high-anion-gap metabolic acidosis.

The patient was a 28-year-old male who was …

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ED sedation with droperidol is relatively safe and effective

May 19, 2015, 7:57 pm


The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department. Calver L et al. Ann Emerg Med 2015 Apr 11 [Epub ahead of print]


Before the Food and Drug Administration issued a black box warning in 2001 regarding the relationship between droperidol and risk of QTc prolongation, the drug had been used for …

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27 fatalities from laboratory-confirmed exposure to PMMA (“Dr. Death”)

April 18, 2015, 2:22 pm


Deaths from exposure to paramethoxymethamphetamine in Alberta and British Columbia, Canada: a case series. Nicol JJE et al. CMAJ Open. 2015 Jan 13;3(1):E83-9

Full Text

From June 2011 through April 2012, 27 deaths in the Canadian provinces of Albert and British Columbia were attributed to the hallucinogenic stimulant para-methoxy-N-methylamphetamine (PMMA) as the primary toxic agent based …

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There is no real evidence on treating calcium channel blocker overdose

November 6, 2014, 8:06 pm


Treatment of calcium channel blocker poisoning: A systematic review. St-Onge M et al. Clin Toxicol 2014 Nov;52:926-944.


This systematic review is massive, thorough, intimidating, and all but unreadable.

As a prelude to establishing a clinical guideline for treatment of calcium channel blocker (CCB) overdose, the 14 Canadian authors systematically searched and evaluated relevant literature. They initially identified 15,577(!) citations, …

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Must-read: marketing vs. medicine in the case of Pradaxa (dabigatran)

July 27, 2014, 8:01 pm


Dabigatran: how the drug company withheld important analyses. Cohen D. BMJ 2014 Jul 23;349:g4670. doi: 10.1136/bmj.g4670.

Full Text

As TPR has reported before, there has long been reason to doubt the claim that the anticoagulant dabigatran (Pradaxa) can be safely and effectively used for prevention of strokes in patients with non-valvular atrial fibrillation without laboratory monitoring.

This must-read investigative …

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Must-read: getting started in online emergency medicine education and FOAMed

June 28, 2014, 6:40 pm


Five Strategies to Effectively Use Online Resources in Emergency Medicine. Thoma B et al. Ann Emerg Med 2014 Jun 21 [Epub ahead of print]


FOAM (Free Open Access Meducation) was born, legend has it, in 2012 during an international conference in Dublin, as Dr. Mike Cadogan  stared into the dregs of a pint of …

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This makes it clear: stoned driving is indeed dangerous

May 4, 2014, 3:36 pm

This investigative report from KIRO-7 Eyewitness News in Seattle is a surprisingly good illustration of the effects of marijuana smoking on driving skills. It would have been even better if the piece was more clear on the concept of a “legal limit.”

There are some people on the internet and in print arguing that driving under the influence of THC …

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Effects of marijuana on driving ability

April 9, 2014, 6:31 pm



Medical Marijuana and Driving: a Review. Neavyn MJ et al. J Med Toxicol 2014 Mar 20 [Epub ahead of print]


This excellent and comprehensive review of literature related to the possible effects of marijuana on driving skills is a must-read for anyone dealing with forensics and medical-legal cases related to the topic, or consulting with government agencies on regulatory …

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