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Suboxone and the Emergency Physician: Get Waivered Training
by Saishravan Shyamsundar, BS
Aug 12, 2022
Clinical scenario: A 56-year-old male with a past medical history of opioid use disorder presents to the emergency department with acute on chronic...
Tactical Medicine News
ACMT Toxicology Visual Pearl: Pretty (and Deadly) in Purple
What is the correct antidote for a patient who is poisoned with the pictured substance?
Digoxin Specific Fab
Hydroxocobalamin/Sodium Thiosulfate...
Tactical Medicine News
ACMT Toxicology Visual Pearl | Substance-Induced Crystalluria: All That Glitters Is Not Gold
Which of the substances below causes crystalluria with hexagonal crystals that shimmer on macroscopic urine examination?
Acyclovir
Ethylene glyc...
Tactical Medicine News
Interpretation and Limitations of Opiate Urine Drug Tests
Background Urine drug tests are commonly sent for patients in the emergency department, however care should be taken when interpreting the results ...
Tactical Medicine News
Should Diphenhydramine be included in an Acute Agitation Regimen?
Background Acute agitation in the emergency department is a common issue that frequently requires the use of chemical sedation to preserve safety f...
Tactical Medicine News
ACMT Toxicology Visual Pearl: Hypertension and Rash
Which toxic exposure can present with the pictured rash along with hypertension and tachycardia mimicking pheochromocytoma?
Arsenic
Lead
Mercury...
Tactical Medicine News
Are Thrombolytics Safe for Acute Ischemic Strokes in Patients on DOACs?
Background Direct-acting oral anticoagulants (DOACs), including apixaban, rivaroxaban, edoxaban, and dabigatran, are widely used for various indica...
Tactical Medicine News
ACMT Toxicology Visual Pearl: Sink or Swim
What type of Mothball floats in both water and saturated salt solution?
Camphor
Naphthalene
Paradichlorobenzene
Sodium Hypochlorite
Tactical Medicine News
Extracorporeal Treatment Options in Poisoned Patients
Background Caring for a patient that is critically-ill secondary to a toxic ingestion is complicated and, in severe cases, extracorporeal treatment...
Tactical Medicine News
Oral Antivirals for Treatment of Mild-Moderate COVID-19 Infection
Background Two new oral agents were given Emergency Use Authorization to be used in patients with mild-moderate COVID-19 at high risk of progressio...
Tactical Medicine News
Balanced Fluids in Diabetic Ketoacidosis
Background Many guidelines and treatment algorithms for diabetic ketoacidosis (DKA) recommend sodium chloride 0.9% as the replacement fluid of choi...
Tactical Medicine News
Simplified Dosing Scheme for DigiFab® in Acute Digoxin Poisoning
Background Treatment of digoxin toxicity can be quite complex and generally involves the use of digoxin immune Fab (DigiFab®) for symptomatic patie...
Tactical Medicine News
Breaking the Cycle: ED Management of Cannabinoid Hyperemesis Syndrome
What is cannabinoid hyperemesis syndrome? Cannabinoid hyperemesis syndrome (CHS) is a condition in which patients who have been using cannabis or s...
Tactical Medicine News
Succinylcholine and the Risk of Hyperkalemia
Background Succinylcholine is frequently used in the ED to facilitate intubation, but it may be avoided in some cases due to the risk of hyperkalem...
Tactical Medicine News
High-Dose Nitroglycerin for Sympathetic Crashing Acute Pulmonary Edema
Background Nitroglycerin (NTG) is an important intervention to consider for patients with Sympathetic Crashing Acute Pulmonary Edema (SCAPE) as it ...
Tactical Medicine News
Beta-Blockers for Inhalant-Induced Ventricular Dysrhythmias
Background There are a few unique scenarios when beta-blockers may be indicated for patients in cardiac arrest. Use of esmolol for refractory ventr...
Tactical Medicine News
Utility of Nebulized Naloxone
Background Naloxone can be administered via multiple routes, with nebulization gaining popularity in the past decade. A previous ALiEM Trick of the...
Tactical Medicine News
ACMT Toxicology Visual Pearl: Questions about green pee? Urine luck!
Which of the following medications is likely responsible for this urine discoloration in an intubated and sedated ICU patient?
Fentanyl
Ketamine...
Tactical Medicine News
Bupropion Overdose: Factors Associated with Seizures
Background Bupropion ingestions are one of the scarier poisonings due to a relatively narrow therapeutic index and the numerous adverse effects tha...
Tactical Medicine News
One-Time Vancomycin Doses in the Emergency Department
Background A previous ALiEM post from 2013 by an EM pharmacist colleague argued the case against one-time vancomycin doses in the ED prior to disch...
Tactical Medicine News
Safety and Efficacy of Clevidipine for Acute Blood Pressure Control
Background Rapid and precise control of blood pressure is vital for patients with a hypertensive emergency or an acute stroke. Commonly, nicardipin...
Tactical Medicine News
Droperidol for Agitation in Older Adults in the Emergency Department
Droperidol is safe and effective for the treatment of severely agitated patients in the ED [1-3]. But what about its use for agitation in elderly p...
Tactical Medicine News
Is Lactated Ringer’s Solution Safe for Hyperkalemia Patients?
Background There are three primary fluids used for resuscitation, each contains varying amounts of potassium per liter (Table 1): 0.9% Sodium Chlor...
Tactical Medicine News
ACMT Toxicology Visual Pearls – In “Spore” Taste
A 15-year-old male presents symptomatic several hours after inhaling spores of this mushroom as a home remedy for epistaxis. What is the presenta...
Tactical Medicine News
ACMT Toxicology Visual Pearls – Necrotic Spider Bite
A patient bitten by the pictured creature with the pictured lesion should be screened for which pathology?
Acute liver failure
Ascending paralysi...
Tactical Medicine News
Colchicine Toxicity: A New Threat from COVID-19 Treatments
In the continued fight against COVID-19, a January 22, 2021 press release from the Montreal Heart Institute touted the potential of colchicine, cit...
Tactical Medicine News
2020 ACLS Guidelines on Medications for Toxicology-Related Conditions
The 2020 ACLS guidelines provide recommendations on the medication-specific management recommendations for toxicology [1]. Although the name of the...
Tactical Medicine News
2020 ACLS Guidelines on Medications for Management of Specific Arrhythmias
The 2020 ACLS guidelines provide recommendations on the medication-specific management for arrhythmias including wide-complex tachycardia, regular ...
Tactical Medicine News
2020 ACLS Guidelines on Vasopressors and Non-Vasopressors During Cardiac Arrest
The 2020 ACLS Guidelines were published in October 2020 [1]. This first of 3 blog posts will focus on vasopressor and non-vasopressor medications d...
Tactical Medicine News
ACMT Toxicology Visual Pearls – A Poke in the Belly
Which component of the pictured plant is the cause of gastrointestinal symptoms when ingested?
Histamine
Lectins
Oxalates
Ribosomal inhibiting p...
Tactical Medicine News
Buprenorphine prescribing: The Get Waivered Initiative makes it easier to get your DEA-X Waiver
A major development in curbing the opioid epidemic is the introduction of the medication buprenorphine to address opioid addiction. Being able to p...
Tactical Medicine News
SAEM Clinical Image Series: Surfing Sting
A 38-year-old male presents 8 days after being stung in the left foot while surfing. He reports the sudden onset of sharp pain while walking in t...
Tactical Medicine News
ACMT Toxicology Visual Pearls: Case of a Toxic Tea
The plant pictured is used as a tea, powder, or capsule by individuals looking to self-treat pain or opioid use disorder. Patients may develop nau...
Tactical Medicine News
SAEM Clinical Image Series: Red, White, & Blue
A 29-year-old female presented to the emergency department for a rash on her right calf. 5 days prior, at her home in Alabama, the patient develo...
Tactical Medicine News
ACMT Toxicology Visual Pearls: “I have a nanging feeling about this”
Chronic exposure to which substance can cause this finding on a Cervical Spine MRI?
Arsenic
Carboplatin
Nitrous Oxide
Toluene
Tactical Medicine News
ACMT Toxicology Visual Pearls: Awake Seizures?
Which of the following rodenticides, often used to kill the rodent pictured, causes seizure-like activity without altered mental status or a post...
Tactical Medicine News
SAEM Clinical Image Series: Juvenile Snake Bite
A 62-year-old male presented thirty minutes after being bitten by a snake in his garden. He stated that he thinks his finger was bitten twice. Th...
Tactical Medicine News
SAEM Clinical Image Series: The Cocaine Gut
A sixty-five-year-old male with a medical history of gastroesophageal reflux disease (GERD), hypertension, alcohol dependence, homelessness, and ...
Tactical Medicine News
ACMT Toxicology Visual Pearls: Perineal Skin Burns
What toxicologic exposure could cause this finding in a 3-year-old child?
Ibuprofen
Miralax
Pseudoephedrine
Senna
Tactical Medicine News
PEM Pearls: Intranasal Medications in the Pediatric ER
Fiona is a 6 year old female who presents to your emergency department after falling onto her left hand while racing on the playground. X-ray of th...
Tactical Medicine News
IDEA Series: Toxicology Virtual Escape Room during COVID-19
In order to enhance emergency medicine (EM) residents’ knowledge of toxicology core content, we previously created an immersive escape room experi...
Tactical Medicine News
ACMT Toxicology Visual Pearls: Caterpillar Envenomation
What is the correct management of dermatitis after handling the creature pictured?
Hot water immersion
Intramuscular epinephrine
Topical applicat...
Tactical Medicine News
PEM Pearls: Metered-Dose Inhaler versus Nebulizer
An 8-year-old is brought in by her parents with shortness of breath and wheezing. She’s been receiving her “rescue inhaler” at home and continues ...
Tactical Medicine News
ACMT Toxicology Visual Pearls: I’ll Huff and I’ll Puff…
The abuse of which common office supply substance can result in syncope and the EKG findings shown?
Dust Off (difluoroethane)
Elmer’s glue (poly...
Tactical Medicine News
Hydroxychloroquine Toxicity
As the COVID-19 pandemic continues to unravel, the role of hydroxychloroquine (HCQ) in the treatment of patients with this disease has been a major...
Tactical Medicine News
ACMT Toxicology Visual Pearls: A Foraging Experience to Die For
What life-threatening symptoms can result from the ingestion of this plant?
Delayed onset bone marrow suppression
Hepatic failure
Mucosal swelli...
Tactical Medicine News
Trick of the Trade: Sodium Bicarbonate for Acute Symptomatic Hyponatremia
A 25-year-old woman is brought into the emergency department by friends due to “acting weird.” She was at a rave and is reported to have consumed ...
Tactical Medicine News
ACMT Toxicology Visual Pearls: The Doom from Down Under
Inadvertent contact with this aquatic species causes excruciating pain and an overwhelming sense of impending doom. What is this?
Box Jellyfish...
Tactical Medicine News
ACMT Toxicology Visual Pearls: Tox Never Smelled So Good
A child presents with tachypnea, tachycardia, and drooling after ingesting the sweet smelling contents of the pictured household item. What toxi...
Tactical Medicine News
ALiEM AIR | Toxicology 2020 Module
Welcome to the AIR Toxicology Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM ...
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