emergency medicine toxicology

EM Quick Hits 1 Massive PE, Gabapentin for Alcohol Withdrawal, Dental Avulsions, Pediatric Eye Exam, Best Resuscitation Fluid

EM Quick Hits is a brand new EM Cases podcast that contains 5 minute segments chosen from 10 specific topics by 10 different experts and educators. These topics are ones that either are not taught very well in training and/or that physicians tend to be not completely comfortable with. They include toxicology, trauma, ophthalmology, orthopaedics, resuscitation, human factors, addiction and pediatric emergencies. The EM Quick Hits Team is: Emily Austin, Peter Brindley, Chris Hicks, Michelle Klaiman, Anna MacDonald, Natalie May, Justin Morgenstern, Andrew Petrosoniak, Hans Rosenberg, Arun Sayal and Anand Swaminathan...

By Anton Helman|2020-11-29T15:07:34-05:00January 15th, 2019|Categories: EM Cases, EM Quick Hits, Emergency Medicine, Medical Specialty, Pediatrics, Resuscitation, Special Populations, Toxicology|Tags: alcohol withdrawal, dental avulsion, gabapentin, massive pulmonary embolism, normal saline, pediatric eye exam, resuscitation fluid|2 Comments

Ep 116 Emergency Management of Opioid Misuse, Overdose and Withdrawal

In this episode Dr. Kathryn Dong, Dr. Michelle Klaiman and Dr. Aaron Orkin discuss the latest in naloxone in opioid overdose cardiac arrest and altered LOA, a 5-step approach to ED opioid withdrawal management and how we can improve mortality and morbidity in patients with opioid use disorder in the era of the opioid epidemic...

By Anton Helman|2022-10-16T08:03:58-04:00October 23rd, 2018|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation, Special Populations, Toxicology|Tags: buprenorphine, COWS Score, naloxone, naltrexone, opioid use disorder, precipitated withdrawal, readiness ruler, SBIRT, suboxone|3 Comments

BCE 76 Opioid Withdrawal

In anticipation of EM Cases Episode 116 on Opioid Misuse, Overdose and Withdrawal, Dr. Michelle Klaiman, Addictions and Emergency Medicine specialist, tells her Best Case Ever exemplifying how we can positively impact the lives of ED patients for years to come - even when they present with simple, run-of-the-mill diagnoses - by thinking outside the box and doing brief screening and interventions for patients with opioid use disorder. She discusses alternative pain control options as well as the use of suboxone to treat opioid withdrawal and opioid addiction.Best Case Ever exemplifying how we can positively impact the lives of ED patients for years to come, even when they present with simple, run-of-the-mill diagnoses, by thinking outside the box and doing brief screening and interventions for patients with opioid use disorder.

By Anton Helman|2023-05-14T17:51:07-04:00October 9th, 2018|Categories: Best Case Ever, EM Cases, Emergency Medicine, Medical Specialty, Special Populations, Toxicology|Tags: brief screening, buprenorphine, Dr. Michelle Klaiman, naloxone, opioid use disorder, suboxone|0 Comments

Ep 115 Emergency Management of the Agitated Patient

Managing acutely agitated patients can cause anxiety in even the most seasoned emergency doctor. These are high risk patients and they are high risk to you and your ED staff. It’s important to understand that agitation or agitated delirium is a cardinal presentation – not a diagnosis. There is pathology lurking beneath - psychiatric, medical, traumatic and toxicological diagnoses driving these patients and we just won’t know which until we can safely calm them down...

By Anton Helman|2022-10-16T10:48:01-04:00September 25th, 2018|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Psychiatry, Resuscitation, Toxicology|Tags: excited delirium, haloperidol, ketamine, Margaret Thompson, midazolam, physical restraints, Reuben Strayer|6 Comments

BCE 75 Reuben Strayer’s Agitated Patient

In anticipation of Episode 115 Management of the Agitated Patient, Dr. Reuben Strayer tells the story of the case that got him interested in developing an expertise around management of the agitated patient that includes an important simple pitfall and pearl about physical restraint. It that could prevent a death in your ED...

By Anton Helman|2023-05-14T17:52:09-04:00September 11th, 2018|Categories: Best Case Ever, EM Cases, Emergency Medicine, Medical Specialty, Psychiatry, Special Populations, Toxicology|Tags: agitation, Dr. Reuben Strayer, physical restraints|1 Comment

Ep 106 Toxic Alcohols – Minding the Gaps

We see patients with toxic alcohol poisoning most commonly in three clinical scenarios. One, after an intentional suicide attempt where they tell you exactly what they took; two, when they come in agitated and won’t give you a history and the three, the inebriated patient found down. Alcohol is everywhere, and inevitably inebriated people show up at your ED with a myriad of medical and psychiatric problems. It’s our job as ED professionals, not only to identify traumatic, medical and psychiatric catastrophes in these patients but also to identify and manage the relatively rare but potentially life and sight threatening toxicologic diagnoses in the inebriated or agitated patient. And that isn’t so easy - especially when it comes to toxic alcohols. In this episode we help give you the knowledge of toxic alcohol poisoning recognition, clinical and lab clues, limitations of the osmolar gap, goals of management, time sensitive treatments and more...

By Anton Helman|2022-10-19T06:32:57-04:00January 30th, 2018|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Toxicology|Tags: dialysis, diethylene glycol, Emily Austin, ethanol, ethlyne glycol, fomepizole, isopropyl alcohol, Margaret Thompson, metabolic aci, methanol, osmolar gap|1 Comment

BCE 64 Salicylate Poisoning

In this EM Cases Best Case Ever Hans Rosenberg and Rajiv Thavanathan discuss recognition and management pearls and pitfalls in salicylate poisoning. They answer question such as: What are the most important diagnostic clues of salicylate poisoning in the patient who presents with undifferentiated fever and altered level of awareness? What is the best timing and ventilation strategy for intubation? Which electrolyte abnormalities do you need to be on the lookout for? and many more...

By Anton Helman|2020-05-15T09:25:01-04:00December 5th, 2017|Categories: Best Case Ever, EM Cases, Medical Specialty, Toxicology|Tags: acid-base, alkalinazation, GOLDMARK, Hans Rosenberg, hemodialysis, metabolic acidosis|3 Comments

Best Case Ever 56 Anion Gap Metabolic Acidosis

In this month's Best Case Ever on EM Cases Dr. Ross Claybo and Dr. Keerat Grewal tell the story of a patient with a complicated anion gap metabolic acidosis. We discuss how to sort through the differential diagnosis with a better mnemonic than MUDPILES, the controversy around administering sodium bicarbonate for metabolic acidosis, the indications for fomepizole and the value of taking time to to build a therapeutic relationship with your ED patients...

By Anton Helman|2020-05-15T09:16:59-04:00March 28th, 2017|Categories: Best Case Ever, EM Cases, Emergency Medicine, Medical Specialty, Toxicology|Tags: fomepizole, GOLDMARK, hyperkalemia, Keerat Grewal, ketoacidosis, MUDPILES, osmolar gap, renal failure, Ross Claybo, sodium bicarbonate, toxic alcohols|3 Comments

Episode 90 – Low and Slow Poisoning

One of the things we need to think about whenever we see a patient who’s going low and slow with hypotension and bradycardia is an overdose. B-blockers, calcium channel blockers (CCB) and digoxin are some of the most frequently prescribed cardiovascular drugs. And inevitably we’re gonna be faced with both intentional and unintentional overdoses from these drugs in the ED. If we can recognize these overdoses early and manage them appropriately, well - we’ll save some lives...

By Anton Helman|2021-03-30T14:37:46-04:00January 3rd, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Toxicology|Tags: activated charcoal, b-blocker, CCB, digifab, digoxin, Emily Austin, gastric lavage, high dose insulin, intralipid, lipid emulsion, Margaret Thompson, whole bowel irrigation|4 Comments

Episode 87 – Alcohol Withdrawal and Delirium Tremens: Diagnosis and Management

Alcohol withdrawal is everywhere. We see over half a million patients in U.S. EDs for alcohol withdrawal every year. Despite these huge volumes of patients and the diagnosis of alcohol withdrawal seeming relatively straightforward, it’s actually missed more often than we’d like to admit, being confused with things like drug intoxication or sepsis. Or it’s not even on our radar when an older patient presents with delirium. What’s even more surprising is that even if we do nail the diagnosis, observational studies show that in general, alcohol withdrawal is poorly treated. So, to help you become masters of alcohol withdrawal management, our guest experts on this podcast are Dr. Bjug Borgundvaag, an ED doc and researcher with a special interest in emergency alcohol related illness and the director of Schwartz-Reismann Emergency Medicine Institute, Dr. Mel Kahan, an addictions specialist for more than 20 years who’s written hundreds of papers and books on alcohol related illness, and the medical director of the substance use service at Women’s College Hospital in Toronto, and Dr. Sara Gray, ED-intensivist at St. Michael's Hospital...

By Anton Helman|2021-03-30T14:41:11-04:00October 25th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Special Populations, Toxicology|Tags: benzodiazepine, Bjug Borgundvaag, CIWA, dexmeditomidine, Mel Kahan, phenobarbital, Sara Gray, SHOT, thiamine|9 Comments