Toxicology

Botulism due to Drug Use

Timothy Hoffman, MD* and Jennifer Yee, DO*

DOI: https://doi.org/10.21980/J8Q93B Issue 8:2 No ratings yet.
ABSTRACT: Audience: This scenario was developed to educate emergency medicine residents on the diagnosis and management of wound botulism secondary to injection drug use.  Introduction: Botulism is a relatively rare cause of respiratory failure and descending weakness in the United States, caused by prevention of presynaptic acetylcholine release at the neuromuscular junction. This presentation has several mimics, including myasthenia gravis
Current IssueSimulationToxicology

Anticholinergic Toxicity in the Emergency Department

C Eric McCoy, MD, MPH* and Reid Honda, MD^ 

DOI: https://doi.org/10.21980/J8D07Z Issue 8:1 No ratings yet.
By the end of this simulation case, learners will be able to: 1) describe the classic clinical presentation of anticholinergic toxicity, 2) discuss common medications and substances that may lead to anticholinergic toxicity, 3) recognize the electrocardiogram (ECG) findings in anticholinergic toxicity that require specific therapy, and 4) review the management of anticholinergic toxicity.
SimulationToxicology

Electrocardiogram Abnormalities Following Diphenhydramine Ingestion: A Case Report

Patrick Bruss, MD*, Christine Bowman, MD* and Teagan Carroll, BS*

DOI: https://doi.org/10.21980/J85H1P Issue 8:1 No ratings yet.
The blue arrow points to one of the terminal R waves in aVR, and the green arrow points to one of the large S waves in lead I, indicating right axis deviation. These findings are pathognomonic for sodium channel blockade. Due to the specific ECG findings and knowledge of diphenhydramine overdose, it was evident that these ECG findings were due to a cardiac sodium channel blockade. Sodium channels are essential within myocardial tissue to ensure the rapid upstroke of cardiac action potential, as well as rapid impulse conduction throughout cardiac tissue. Therefore, sodium channel blockers tend to exhibit significant dysrhythmic properties due to severe conduction disturbances.2 The blockage of the cardiac sodium channels appears as terminal R waves in aVR as well as terminal S waves in lead I due to delaying, and possibly blocking, the electrical conduction pathway of the heart. The orange arrows show resolution of terminal R wave in aVR and terminal S wave in lead I, after administration of sodium bicarbonate.
PediatricsToxicologyVisual EM

Methemoglobinemia

Ibrahim Alagha, BS*, Ghadeer Doman, MD^  and Shaza Aouthmany, MD†

DOI: https://doi.org/10.21980/J8PH1B Issue 7:4 No ratings yet.
At the end of this simulation case, participants should be able to: 1) recognize shortness of breath, cyanosis and respiratory distress, and the difference between all of them based on the clinical presentation 2) identify the underlying cause of the condition by conducting a thorough history and physical 3) know how to identify and treat methemoglobinemia by ordering necessary labs and interventions and understand the pathophysiology leading to methemoglobinemia 4) recognize patient’s response to treatment and continue to reassess.
SimulationToxicology

Mushroom for Improvement Case Report: The Importance of Involving Mycologists

Gary Bhagat, MD*, Marit Tweet, MD^ and Steven Aks, MD^†

DOI: https://doi.org/10.21980/J8ZW7W Issue 7:4 No ratings yet.
The mushroom displayed here is large and lacks any gills. Small puffball mushrooms can resemble young immature button top Amanita type mushrooms. Opening the Amanita mushroom should reveal apparent gills and quickly differentiate the two- -the puffball mushroom should have a white interior without gills.
Abdominal/GastroenterologyToxicologyVisual EM

Cyanide Poisoning

Ghadeer Doman, MD*, Jihad Aoun, MS^, Joshua Truscinski, MS^, Mariah Truscinski, MD^ and Shaza Aouthmany, MD^

DOI: https://doi.org/10.21980/J80W76 Issue 7:3 No ratings yet.
After the completion of this simulation, participants will have learned how to: 1) identify clues of smoke inhalation based on a physical examination; 2) identify smoke inhalation-induced airway compromise and perform definitive management; 3) create a differential diagnosis for victims of fire cyanide poisoning, carbon monoxide, and carbon dioxide; 4) appropriately treat cyanide poisoning; 5) demonstrate the importance of preemptively treating for cyanide poisoning; 6) perform an initial physical examination and identify physical marks suggesting the patient is a fire and smoke inhalation victim; and 7) familiarize themselves with the Cyanokit and treatment with hydroxocobalamin.
SimulationToxicology

Management of Poisoned Patients: Implementing a Blended Toxicology Curriculum for Emergency Medicine Residents

Madeline Dwyer, MD*, Megan Stobart-Gallagher, DO*, Jared Kilpatrick, MD* and Alanna O’Connell, DO^

DOI: https://doi.org/10.21980/J8C937 Issue 7:2 No ratings yet.
The goal of this curriculum is to introduce EM residents to core toxicology concepts and to reinforce toxicology principles through a multimodal approach that leads to increased confidence in the management of poisoned patients on shift.
CurriculumToxicology

Infant Botulism

Victoria Morris, MD*, Robert Wians, MD, MPH*, Jessica Wilson, MD* and Gowri Stevens, MD* 

DOI: https://doi.org/10.21980/J8X35W Issue 7:2 No ratings yet.
After this simulation learners should be able to: 1) develop a differential diagnosis for the hypotonic infant, 2) recognize signs and symptoms of infant botulism, 3) recognize respiratory failure and secure the airway with appropriate rapid sequence intubation (RSI)  medications, 4) initiate definitive treatment of infant botulism by mobilizing resources to obtain antitoxin, 5) continue supportive management and admit the patient to the pediatric intensive care unit (PICU), 6) understand the pathophysiology and epidemiology of infant botulism, 7) develop communication and leadership skills when evaluating and managing critically ill infants. 
PediatricsSimulationToxicology

Let’s Escape Didactics: Virtual Escape Room as a Didactic Modality in Residency

Anisha Turner, MD*, Aleksandr M Tichter, MD, MS* and M Tyson Pillow, MD, MEd*

DOI: https://doi.org/10.21980/J8CH2X Issue 6:2 No ratings yet.
By the end of the activity, learners should be able to: 1) identify the hazardous chemicals associated with house fires; 2) classify burn injury according to depth, extent and severity based on established standards; 3) recall the actions to take in response to fire emergencies (R.A.C.E. and P.A.S.S. acronyms); 4) recall key laboratory features of cyanide and carbon monoxide poisonings; 5) identify appropriate management strategies for smoke inhalation injuries; 6) recite the treatment for cyanide and carbon monoxide poisonings; 7) describe the management of the burn injuries; 8) communicate and collaborate as a team to arrive at solutions of problems; 9) display task-switching and leadership skills during exercise; and 10) evaluate virtual escape room experience.
Small Group LearningToxicology

Botulism

John Thompson, MD*, Zane Horowitz, MD* and Adam Blumenberg, MD*^

DOI: https://doi.org/10.21980/J8FD0R Issue 6:1 No ratings yet.
By the end of this simulation learners will be able to: 1) develop a differential for descending paralysis and recognize the signs and symptoms of botulism; 2) understand the importance of consulting public health authorities to obtain botulinum antitoxin in a timely fashion; 3) recognize that botulism will progress during the time period antitoxin is obtained. Early indications of respiratory compromise are expected to worsen during this time window. Secondary learning objectives include: 4) employ advanced evaluation for neurogenic respiratory failure such as physical examination, negative inspiratory force (NIF), forced vital capacity (FVC), and partial pressure of carbon dioxide (pCO2), 5) discuss and review the pathophysiology of botulism, 6) discuss the epidemiology of botulism.
NeurologySimulationToxicology