Tox Tunes #97: Resurrection Mary (Ian Hunter)
Combining Chicago lore, poisons, and a ghost, this is the perfect “Tox Tune” to post the weekend before smaccUS descends on the Windy City.
“Resurrection Mary,” which appeared on Ian Hunter’s 1996 album The Artful Dodger, recounts the famous Chicago ghost story involving about a vanishing hitchhiker who is periodically sited near the Resurrection Cemetery in southwest suburban Justice. Legend has it that the hitchhiker is the ghost of a young girl killed by an automobile in the late 1920s or early 1930s while trying to get away from her boyfriend.
As recounted by Wikipedia:
Since the 1930s,...
Source: The Poison Review - June 21, 2015 Category: Toxicology Authors: Leon Tags: Medical Chicago ian hunter resurrection mary tox tunes Source Type: news
Looking back: the first FOAMed meeting in the U.S.
This photograph, from November 2010, documents what was to my knowledge the first #FOAMed get-together on U.S. soil. Gathered that evening at a tapas restaurant in San Francisco during the “Essentials of EM” conference were (from left to right):
Anton Helman (Emergency Medicine Cases)
Chris Nickson (Life in the Fast Lane)
Scott Weingart (EMCrit)
Michelle Lin (Academic Life in Emergency Medicine)
Leon Gussow (The Poison Review)
It is truly amazing to realize that only four-and-a-half years later, 2000 foamheads from around the world are descending on Chicago for the 3-day festival of life and learning calle...
Source: The Poison Review - June 20, 2015 Category: Toxicology Authors: Leon Tags: Medical FOAM FOAMed FOAMtox smaccus Source Type: news
Illustrated case report of phenol exposure
Phenol
3.5 out of 5 stars
Phenol Toxicity Following Cutaneous Exposure to Creolin®:A Case Report. Vearrier D et al. J Med Toxicol 2015 Jun;11:227-231.
Abstract
This paper is worth looking at for the excellent color photographs of the partial thickness skin burns induced by exposure to Creolin®, which contains carbolic acid (phenol), sodium hydroxide, and isopropanol.
A 9-year-old girl was brought to the emergency department because of respiratory distress and unresponsiveness. Symptoms came on quickly and started within 4 minutes of the mother pouring 8 oz Creolin® over the patients hair in an attempt to get rid of hea...
Source: The Poison Review - June 18, 2015 Category: Toxicology Authors: Leon Tags: Medical coagulative necrosis creolin phenol surface burn Source Type: news
Case series: 11 hospital workers symptomatic after ingesting “synthetic marijuana” brownies
3 out of 5 stars
Cluster of Acute Toxicity from Ingestion of Synthetic Cannabinoid-Laced Brownies. Obafemi AI et al. J Med Toxicol 2015 May 13 [Epub ahead of print]
Abstract
This case series describes 11 patients brought to hospital after inadvertently ingesting brownies laced with the synthetic cannabinoid AM-2201.
All 11 patients were hospital workers who ingested brownies brought to work by a staff member. In each patient, symptoms started within an hour of ingestion and generally resolved within 2 to 4 hours (although two persons felt tired and dizzy for up to 10 hours post-ingestion.) The most common neurological ma...
Source: The Poison Review - June 16, 2015 Category: Toxicology Authors: Leon Tags: Medical acute toxicity AM-2201 ingestion synthetic cannabinoid Source Type: news
Podcast: Managing the crashing tox patient with ECMO
As I wrote about in a recent column for Emergency Medicine News, extracorporeal membrane oxygenation (ECMO) may be the next big thing in managing the severely ill, crashing overdose patient in whom usual therapy is not working. On the new podcast posted today at the EDECMO website, Steve Aks and I got together over Skype with Joe Bellezzo, Zack Shinar, and Scott Weingart to discuss the potential benefits, as well as the potential risks and complications, involved in using ECMO in the sickest tox patients.
Some of the topics we discuss:
What overdose patients might benefit most from ECMO?
What vascular access is needed fo...
Source: The Poison Review - June 16, 2015 Category: Toxicology Authors: Leon Tags: Medical ECMO edecmo extracorporeal membrane oxygenation podcast poisoning toxicology Source Type: news
Dramatic recent increase in cases and deaths associated with use of synthetic cannabinoids
4 out of 5 stars
Increase in Reported Adverse Health Effects Related to Synthetic Cannabinoid Use —United States, January-May 2015. MMWR 2015 Jun 12;64:618-619.
Full Text
I have to say that this report shocked me some. Although I was aware of an increased number of news reports of incidents related to synthetic cannabinoids, I really had no idea the increased number of cases involving exposures reported to poison centers with major adverse effects and death were so dramatic.
As this report points out:
“Synthetic cannabinoids include various psychoactive chemicals or a mixture of such chemicals that are sprayed ont...
Source: The Poison Review - June 13, 2015 Category: Toxicology Authors: Leon Tags: Medical CDC national poison data system spice mmwr synthetic cannabinoid Source Type: news
How lipid rescue therapy works: it’s more than just a sink
This study, from Guy Weinberg’s lab at the University of Illinois, used a rat model of bupivacaine toxicity, along with and computational analysis, to investigate the mechanisms by which lipid rescue therapy (LRT) might act in treating overdose from local anesthetics and other cardiotoxic drugs.
This is a very complex paper, and I have to admit that I found reading through the experimental protocol rough going. However, the authors findings are important and convincing. The results suggest that — as the title of the paper indicates — there are several modalities that provide benefit:
LRT accelerated removal of d...
Source: The Poison Review - June 10, 2015 Category: Toxicology Authors: Leon Tags: Medical antidote bupivacaine intralipid lipid emulsion lipid rescue therapy local anesthetic triglyceride Source Type: news
“Rick and Jerry”: a salute
At the Emergency Physicians Monthly website, Mel Herbert posted a lovely tribute to Rick Bukata and Jerry Hoffman as they pass off the lead anchoring duties on Emergency Medicine Abstracts to a new generation of medical educators.
I think Mel’s piece captures the impact and influence of the Abstracts perfectly. When I started listening to the monthly tapes in the mid-1980s, I found them to be a revelation. Certainly, a critical approach to analyzing medical literature was not taught at all in medical school, although it is certainly one of the most important skills a physician can have. Other packages that tried ...
Source: The Poison Review - June 8, 2015 Category: Toxicology Authors: Leon Tags: Medical emergency medicine abstracts jerry hoffman rick bukata Source Type: news
Tox Tunes #96: Champagne and Reefer (Rolling Stones and Buddy Guy)
This is a great version of Muddy Waters’ song “Champagne and Reefer” by the Stones and Buddy Guy. Those who will be in Chicago for SMACCus may want to stop into Buddy Guy’s Legends, a club that is virtually downtown and where Buddy himself sometimes shows up to play.
Related post:
Tox Tunes #32: Champagne and Reefer (Muddy Waters) (Source: The Poison Review)
Source: The Poison Review - June 8, 2015 Category: Toxicology Authors: Leon Tags: Medical Source Type: news
Tox Tunes #96: Champagne and Reefer (rolling Sontes and Buddy Guy)
This is a great version of Muddy Waters’ song “Champagne and Reefer” by the Stones and Buddy Guy. Those who will be in Chicago for SMACCus may want to stop into Buddy Guy’s Legends, a club that is virtually downtown and where Buddy himself sometimes shows up to play.
Related post:
Tox Tunes #32: Champagne and Reefer (Muddy Waters) (Source: The Poison Review)
Source: The Poison Review - June 8, 2015 Category: Toxicology Authors: Leon Tags: Medical Source Type: news
Episode #9: TPR Podcast on hemodialysis in poisonings
Episode 9: EXTRIP Review
Written by Theresa Kim, MD
Outline
EXTRIP Guideline Methodology
Methanol
Theophylline
Lithium
Acetaminophen
EXTRIP Guideline Methodology
Extracorporeal treatments (ie. hemodialysis, hemoperfusion) are commonly used in poisonings despite lack of formal human trials
Goal of the EXTRIP workgroup was to form an international collaboration among experts from nephrology, toxicology, critical care, pharmacology, and over 30 professional societies to form consensus recommendations and suggestions based on available research and expert opinion
Clinical evidence ranked using GRADE syst...
Source: The Poison Review - June 1, 2015 Category: Toxicology Authors: LeonThe Poison Review Tags: Podcast Source Type: news
Tox Tunes #95: Dead Flowers (Townes Van Zandt)
The Rolling Stones’ original version of “Dead Flowers” was on their 1971 Sticky Fingers album, along with a number of other songs definitely or possibly about drugs, including “Brown Sugar,” “Moonlight Mile,” and “Sister Morphine.”
The song was written in the late 1960s, when Keith Richards was hanging out with the country-rock musician Gram Parsons. Although fans debate whether or not the term “dead flowers” refers to poppies, the other reference to heroin is unmistakable:
I’ll be in my basement room
With a needle and a spoon
I much prefer Townes Van ...
Source: The Poison Review - June 1, 2015 Category: Toxicology Authors: Leon Tags: Medical dead flowers rolling stones townes van zandt tox tunes Source Type: news
Poisoned patients treated with ECMO: 10 cases from the ToxIC Registry
3 out of 5 stars
Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC) Wang GS et al. J Med Toxicol 2015 May 27 [Epub ahead of print]
Abstract
The Toxicology Investigators Consortium (ToxIC) Case Registry — established in 2010 — is a database containing information from cases of known or suspected poisoning at multiple centers that were cared for at the bedside by board-certified or eligible medical toxicologists. In 2013, it comprised 38 toxicology groups and 69 separate institutions.
The authors of this study retrospectively reviewed 4...
Source: The Poison Review - May 30, 2015 Category: Toxicology Authors: Leon Tags: Medical ECMO extracorporeal membrane oxygenation ToxIC registry toxicology investigators consortium Source Type: news
Keys to the safe use of naloxone
4 out of 5 stars
Reducing the harm of opioid overdose with the safe use of naloxone: a pharmacologic review. Kim HK, Nelson LS. Expert Opin Drug Saf 2015 Apr 12:1-10 [Epub ahead of print]
Abstract
This review of naloxone comes down strongly on the side of “less is more,” and argues that when reversing opiate overdose a starting dose of 2 mg — or even 0.4 mg — is unnecessary and risks precipitating acute opiate withdrawal syndrome (OWS).
Although some clinicians will not agree with all the authors’ opinions, they are well thought out and worth considering. Some key points:
Naloxone’s duration o...
Source: The Poison Review - May 28, 2015 Category: Toxicology Authors: Leon Tags: Medical antidote naloxone narcan opiate overdose opioid intoxication Source Type: news
Unlabeled amphetamine isomer in sports supplement “probably” caused hemorrhagic stroke
3.5 out of 5 stars
Hemorrhagic Stroke Probably Caused by Exercise Combined With a Sports Supplement Containing β-Methylphenylethylamine (BMPEA): A Case Report. Cohen P et al. Ann Intern Med 2015 May 12 [Epub ahead of print]
Reference
Last month, the FDA sent letters to 5 companies that manufacture so-called “dietary” or “sports” supplements, warning them that their products were mislabeled because they contained an unlisted ingredient.
That ingredient, β-methylphenylethylamine (BMPEA), is an isomer of amphetamine. Although the effects of BMPEA in humans have not been well studied, it has been ...
Source: The Poison Review - May 22, 2015 Category: Toxicology Authors: Leon Tags: Medical amphetamine beta-methylphenylethylamine BMPEA dietary supplement hemorrhagic stroke sports supplement Source Type: news
