Toxicology

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.

Toxicology Curriculum

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.

Pediatrics Simulation Toxicology

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 Learning Toxicology

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.

Toxicology Neurology Simulation

Approach to the Poisoned Patient

Kennon Heard, MD^* and Matthew Zuckerman, MD^*

DOI: https://doi.org/10.21980/J8264S Issue 6:1 No ratings yet.

By the end of the lecture, learners should be able to: 1) initiate the evaluation of a poisoned patient, 2) identify key interventions to support airway, breathing, and circulation, 3) identify the three components of risk assessment in the poisoned patient, 4) list the four options for gastric decontamination, and 5) select standard diagnostic labs and tests commonly used in evaluating poisoned patients.

Toxicology Lectures

Case Report: Antifreeze Ingestion and Urine Fluorescence

Taras Varshavsky, MD^* and Meigra Myers Chin, MD^*

DOI: https://doi.org/10.21980/J8G05T Issue 5:1 No ratings yet.

The patient’s urine sample (right) was compared to a control (left) using a Wood’s lamp. It revealed light green fluorescence under ultraviolet light, which increased suspicion for ethylene glycol poisoning from antifreeze ingestion.

Toxicology Visual EM

Tricyclic Antidepressant Overdose

Patrick G Meloy, MD^*, Amit Bhambri, MD^{^} and Megan C Henn, MD^*

DOI: https://doi.org/10.21980/J85W50Issue 4:3 No ratings yet.

At the end of this oral boards session, learners will be able to: 1) discuss the appropriate laboratory testing and workup for a patient with undifferentiated altered mental status, 2) discuss the importance of obtaining an ECG in a timely manner in order to investigate the broad differential of altered mental status, 3) identify the classic ECG findings of a patient with TCA overdose, 4) review the treatment of TCA overdose, 5) discuss the appropriate disposition of a patient with TCA overdose.

Toxicology Oral Boards

Ethylene Glycol Ingestion

Matthew Schwab, MD^* and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J8M620Issue 4:2 No ratings yet.

By the conclusion of the simulation session, learners will be able to: 1) obtain a thorough toxicologic history, including intent, timing, volume/amount, and assessment for co-ingestions, 2) distinguish the variable clinical signs and symptoms associated with toxic alcohol ingestions, 3) identify metabolic derangements associated with toxic alcohol ingestions, 4) discuss the management of toxic alcohol ingestion, 5) appropriately disposition the patient for admission to intensive care unit (ICU).

Simulation Toxicology

Iron Overdose

James Roy Waymack, MD^*, Marit Tweet, MD^* and Richard Austin, MD^*

DOI: https://doi.org/10.21980/J8MD1P Issue 4:1 No ratings yet.

By the end of this oral boards case, learners will: 1) demonstrate evaluation of a patient presenting with toxic ingestion, including obtaining pertinent history, 2) review the signs and symptoms of the different presenting phases of acute iron ingestion, and 3) demonstrate appropriate treatment of iron overdose, namely, iron chelation therapy with deferoxamine.

Toxicology Oral Boards

Cocaine-induced Myocardial Infarction and Pulmonary Edema

Dae-won Lee, MD* and Timothy J Koboldt, MD*

DOI: https://doi.org/10.21980/J8ZS87Issue 3:4 No ratings yet.

By the end of this simulation session, the learners will be able to:1) Determine appropriate diagnostics in a patient with likely cocaine toxicity. 2) Identify and manage respiratory failure. 3) Identify and manage a ST-elevation myocardial infarction (STEMI) and pulmonary edema. 4) Identify and manage cocaine toxicity with benzodiazepines. 5) Determine appropriate disposition of the patient to the cardiac catheterization lab and an intensive care unit (ICU). 6) Demonstrate effective communication and teamwork during resuscitation of a critically ill patient.

Cardiology/Vascular Simulation Toxicology