emergency medicine toxicology

Best Case Ever 33: Over-correction of Hyponatremia

Rapid over-correction of Hyponatremia can have devastating consequences: for one, osmotic demyelination syndrome (ODS) can result in destruction of the pons and a locked-in state. We don't see ODS very much as it's onset is delayed and usually sets in after the patient is admitted to hospital (or worse, sent home). Nonetheless, we need to know how to manage Hyponatremia in the ED so that we prevent ODS from ever happening. In this Best Case Ever, Dr. Melanie Baimel describes the case of a young woman who came in to the ED after drinking alcohol and taking Ecstasy, wanted to leave AMA after her Hyponatremia had inadvertently been corrected too rapidly, and the conundrum that ensues. In the upcoming episode, Dr. Baimel and the first ever Internal Medicine specialist on EM Cases, Dr. Ed Etchels, discuss a rational step-wise approach to managing Hyponatremia, tailored for the EM practitioner; when you might consider giving DDAVP in the ED, the best way to correct Hyponatremia, how to manage the patient who's Hyponatremia has been corrected too quickly, and an easy approach to the differential diagnosis. Get a sneak peak at the algorithm that will be explained and reviewed in the upcoming episode...... [wpfilebase tag=file id=577 tpl=emc-play /] [wpfilebase tag=file id=578 tpl=emc-mp3 /]

By Anton Helman|2019-11-11T17:21:15-05:00February 26th, 2015|Categories: Best Case Ever, Emergency Medicine, Medical Specialty, Toxicology|Tags: DDAVP, ecstasy, MDMA, Melanie Baimel, ODS, osmotic demyelination syndrome|3 Comments

Best Case Ever 26: Chloral Hydrate Poisoning and Cardiac Arrest

I met up with Mike Betzner at North York General's Update in EM Conference in Toronto. He is the medical director of Air Transport STARS air ambulance out of Calgary and an amazing speaker on the national lecturing circuit. His Best Case Ever on Chloral Hydrate poisoning & cardiac arrest describes a young man in cardiac arrest with resistant Ventricular Fibrillation and Torsades de Pointes. There is only one class of drugs that can get him back into normal sinus rhythm. Dr. Betzner describes how he recognized that this patient was suffering from Chloral Hydrate poisoning and how he saved his life with one simple intervention.

By Anton Helman|2017-02-03T13:59:54-05:00July 3rd, 2014|Categories: Best Case Ever, EM Cases, Emergency Medicine, Resuscitation, Toxicology|Tags: b-blocker, cardiac arrest, chloral hydrate, Mike Betzner, Torsades de Pointes|1 Comment

Episode 27: Drugs of Abuse – Stimulants and Opiates

Dr. Margaret Thompson & Dr. Lisa Thurgur Canada's toxicologist gurus discuss several cases of stimulant drugs of abuse such as cocaine, MDMA & bath salts, as well as the pearls and pitfalls of managing opiates toxicity. We discuss: The management of the intoxicated patient including seizures, dysrhythmias, cardiac ischemia and hypertensive emergencies related to cocaine toxicity, the recognition and management of necrotizing vasculitis caused by cocaine cut with Levamisole, the differential diagnosis and management of the "hot and crazy" patient, including the role of dantrolene and cyproheptidine, pearls and pitfalls of naloxone, the utility of urine drug screens and much more....

By Anton Helman|2021-03-31T13:05:16-04:00October 15th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Toxicology|Tags: acute coronary syndrome, bath salts, cocaine, dantrolene, drug screen, dysrhthmia, ecstacy, hypertensive emergency, levamisole, Lisa Thurgur, Margaret Thompson, naloxone, opiate, seizure, sympathomimetic, vasculitis|0 Comments

Best Case Ever 12: Drugs of Abuse

As a bonus to Episode 27 on Drugs of Abuse -Stimulants & Opiates, Dr. Margaret Thompson, one of Canada's leading Toxicologists and the medical director of the Ontario Poison Control Centre tells us 2 of her Best Cases Ever about stimulant overdose surprises. In the related Episode, Dr. Margaret Thompson & Dr. Lisa Thurgur Canada's toxicologist gurus discuss several cases of stimulant drugs of abuse such as cocaine, MDMA & bath salts, as well as the pearls and pitfalls of managing opiates toxicity. We discuss: The management of the intoxicated patient including seizures, dysrhythmias, cardiac ischemia and hypertensive emergencies related to cocaine toxicity, the recognition and management of necrotizing vasculitis caused by cocaine cut with Levamisole, the differential diagnosis and management of the "hot and crazy" patient, including the role of dantrolene and cyproheptidine, pearls and pitfalls of naloxone, the utility of urine drug screens and much more.... [wpfilebase tag=file id=396 tpl=emc-play /] [wpfilebase tag=file id=397 tpl=emc-mp3 /]

By Anton Helman|2019-11-11T21:38:55-05:00October 7th, 2012|Categories: Best Case Ever, EM Cases, Emergency Medicine, Resuscitation, Toxicology|Tags: acute coronary syndrome, bath salts, cocaine, dantrolene, drug screen, dysrhthmia, ecstacy, hypertensive emergency, levamisole, Lisa Thurgur, Margaret Thompson, naloxone, opiate, seizure, sympathomimetic, vasculitis|0 Comments

Episode 13 Part 2: Killer Coma Cases – The Intoxicated Patient

In part 2 of this episode Dr. Helman presents two more cases to Dr. Carr and Dr. Steinhart, who give us their insights into the common conundrums when it comes to the intoxicated ED patient, and some key clues to the not-so-common life threatening toxicological emergencies that we need to be on the look out for.

By Anton Helman|2021-03-31T13:28:03-04:00April 12th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology, Toxicology|Tags: altered mental status, Brian Steinhart, coma cocktail, David Carr, naloxone|2 Comments

Episode 5: Renal Colic, Toxicology Update & Body Packers

This Episode is a potpourri of topics - Renal Colic, Toxicology Update & Body Packers. Dr. Lisa Thurgur and Dr. Paul Rosenberg discuss the common presentation of Renal Colic, with perspectives on the mixed evidence for medical expulsive therapy, the overuse of imaging studies and when we need to worry about the patient who presents with excruciating flank pain. Next, Dr. Thurgur gives us an update on the three most important recent advances in Toxicology for emergency physicians - Lipid Emulsion Therapy, Hydroxocobalamin and Insulin therapy for Calcium Channel Blocker toxicity. Finally, Dr. Rosenberg and Dr. Thurgur discuss the 'ins and outs' of body packers. They review the management of both asymptomatic and symptomatic body backers, highlighting common errors and key therapeutic moves to prevent death.

By Anton Helman|2021-03-31T13:39:46-04:00June 1st, 2010|Categories: EM Cases, Emergency Medicine, Episodes, Genitourinary, Toxicology|Tags: body packer, calcium channel blocker, cocaine, hydroxocobalamin, lipid emulsion, Lisa Thurgur, nephrolithiasis, pain management, renal colic|0 Comments

Episode 2: Excited Delirium

Dr. Margaret Thompson, Canada's toxicology guru and Dr. Dan Cass review the clinical presentation, precipitating factors and important do's and don'ts in managing patients with Excited Delirium Syndrome to prevent sudden death. They update us on the most current guidelines for Excited Delirium Syndrome and discuss the prevalent theories to explain why many of these patients have cardiac arrests. Excited Delirium Syndrome has recently been recognized by the American College of Emergency Physicians as a true medical emergency in which, typically, a young obese male, often under the influence of sympathomimetic drugs, becomes acutely delirious and displays super-human strength, tachypnea, profuse sweating and severe agitation. Usually, there is a prolonged and continued struggle with law enforcement despite physical restraints . Severe acidosis, rhabdomyolysis and hyperkalemia ensue, often leading to a sudden bradyasystolic cardiac arrest. Listen to this fascinating episode to find out how you can recognize and treat this important syndrome.

By Anton Helman|2021-03-29T19:05:13-04:00March 9th, 2010|Categories: EM Cases, Emergency Medicine, Episodes, Psychiatry, Resuscitation, Toxicology|Tags: acidosis, cardiac arrest, delirium, hyperthermia, Margaret Thompson, sympathomimetic|3 Comments