Toxicology

Calcium Channel Blocker Overdose

Jessica G Andrusaitis, MD, MS* and Alan Givertz, MD^

DOI: https://doi.org/10.21980/J8CQ07Issue 9:1[mrp_rating_result]
At the end of this oral board session, examinees will: (1) demonstrate ability to evaluate a patient with undifferentiated shock with bradycardia and discuss the differential diagnosis, (2) recognize the signs and symptoms of calcium channel blocker overdose, (3) demonstrate ability to manage treatment of a patient with calcium channel overdose.
Cardiology/VascularCertifying Exam CasesToxicology

Alcohol Withdrawal with Delirium Tremens

Courtney Schwebach, MD* and Amrita Vempati, MD*

DOI: https://doi.org/10.21980/J8S35N Issue 8:3[mrp_rating_result]
By the end of the session, learner will be able to  1) discuss the causes of altered mental status,  2) utilize CIWA scoring system to quantify AW severity, 3) formulate appropriate treatment plan for AW by treating with benzodiazepine and escalating treatment appropriately, 4) treat electrolyte abnormalities by giving appropriate medications for hypokalemia and hypomagnesemia, and 5) discuss clinical progression and timing to AW.
SimulationToxicology

Infant Botulism

Ashley Garispe, DO* and Steven Cherry, MD^

DOI: https://doi.org/10.21980/J88350 Issue 8:3[mrp_rating_result]
At the end of this oral board session, examinees will: 1) demonstrate an ability to obtain a complete pediatric medical history, 2) perform an appropriate physical exam on a pediatric patient, 3) investigate a broad differential diagnosis for neuromuscular weakness in a pediatric patient, 4) recognize the classic presentation of infant botulism and implement treatment with botulinum specific antitoxin before confirmatory testing, 5) recognize impending airway failure and intubate the pediatric patient with appropriately dosed medications and ET tube size, and 6) demonstrate effective communication with healthcare team members and parents. 
ToxicologyCertifying Exam Cases

Botulism due to Drug Use

Timothy Hoffman, MD* and Jennifer Yee, DO*

DOI: https://doi.org/10.21980/J8Q93B Issue 8:2[mrp_rating_result]
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
SimulationToxicology

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[mrp_rating_result]
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.
ToxicologySimulation
Creative Commons images

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[mrp_rating_result]
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.
ToxicologyPediatricsVisual EM

Methemoglobinemia

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

DOI: https://doi.org/10.21980/J8PH1B Issue 7:4[mrp_rating_result]
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.
ToxicologySimulation
Creative Commons images

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[mrp_rating_result]
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