Rant: ultrasound visualization of pills in the stomach will never make sense
Konstantin Shevtsov/shutterstock.com 2 out of 5 stars Accuracy of Trans-Abdominal Ultrasound in a Simulated Massive Acute Overdose. Sullivan S et al.  Am J Emerg Med 2016 Apr 23 [Epub ahead of print] Abstract As soon as emergency portable bedside ultrasound became feasible approximately three decades ago, toxicologists wondered if it would be a useful modality for visualizing pills in the stomach of overdose patients. The answer, clearly, is no it would not. This misguided paper illustrates why. This randomized study had a study group (N=10) and a control group (N=10) ingest 50 enteric-coated placebo capsules plus 1 L fl...
Source: The Poison Review - May 25, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical activated charcoal acute ingestion gastric lavage sonography ultrasound whole bowel irrigation Source Type: news

5-MAPB: a novel psychoactive benzofuran
3.5 out of 5 stars Acute Toxicity Associated With the Recreational Use of the Novel Psychoactive Benzofuran N-methyl-5-(2 aminopropyl)benzofuran. Sofer KE et al. Ann Emerg Med 2016 Apr 26 [Epub ahead of print] Abstract 5-MAPB is a psychoactive benzofuran with a structure and effects similar to those of MDMA (Ecstasy.) Although there has been scant investigation of its pharmacologic and toxic effects, animal studies indicate that it inhibits re-uptake of monoamines, especially serotonin. This case report from Zurich Switzerland describes a patient with laboratory-confirmed exposure to 5-MAPB. He presented with signs an...
Source: The Poison Review - May 24, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical 5-MAPB 5_APB bensofuran benzo fury ecstasy mdma psychoactive Source Type: news

Absolute must-read: LA Times on the myth of OxyContin’s 12-hour analgesic effect
Quick: how long does a dose of Oxycontin provide pain relief? Most clinicians would probably say 12 hours, since the drug was extensively marketed as a twice-daily opioid analgesic and the manufacturer — Purdue Pharma — cited this originally unique convenience factor as justifying its high cost, which could exceed $630 a bottle. In an explosive and masterfully written investigative piece by Harriet Ryan, Lisa Girion and Scott Glover,  the Los Angeles Times reported this week that in most patients the duration of the analgesic effect for OxyContin does not last nearly as long as claimed, and that this discrepancy may b...
Source: The Poison Review - May 8, 2016 Category: Toxicology Authors: Leon Gussow Tags: Best of TPR Medical 12-hour myth Los Angeles Times opiate opioid addiction oxycontin Purdue Pharma Source Type: news

Cardiac effects of loperamide overdose
3 out of 5 stars Not your regular high: cardiac dysrhythmias caused by loperamide. Wightman RS et al. Clin Toxicol 2016 Jun;54:454-458 Abstract Loperamide is an over-the-counter anti-diarrhea medication that is available without prescription under a variety of brand names including Imodium. In therapeutic doses, loperamide acts as a peripheral mu-opioid receptor agonist but doesn’t cross the blood-brain barrier (BBB). However, in massive overdose loperamide can enter the brain and cause central opioid toxicity, including altered mental status and respiratory. Although previously loperamide was thought to have litt...
Source: The Poison Review - April 29, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical cardiac effects cardiogoxicity long QT loperamide overdose QRS interval qt interval Source Type: news

Bedside echocardiography findings in carbon monoxide-poisoned patients
4 out of 5 stars Incidence and patterns of cardiomyopathy in carbon monoxide-poisoned patients with myocardial injury. Cha YS et al. Clin Toxicol 2016 Apr 11 [Epub ahead of print] Abstract At last year’s Social Media and Critical Care (SMACC) conference in Chicago, I gave a talk remarking on how bedside ultrasound imaging in critically ill toxicology patients is underused and little studied. I suggested that it could provide crucial information in a number of settings. For example, visualizing the inferior vena cava (IVC) in salicylate toxicity to help guide rehydration, or evaluating left ventricular (LV) function...
Source: The Poison Review - April 29, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical bedside emergency ultrasound carbon monoxide cardiomyopathy echocardiography left ventricular dysfunction takotsubo Source Type: news

NBC Nightly News: Fentanyl Overdoses on the Rise
NBC Nightly News on the skyrocketing numbers of overdose deaths attributed to fentanyl. And yes, that is Steve Aks at 2:14. (Source: The Poison Review)
Source: The Poison Review - April 25, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical deaths fatality fentanyl NBC Nightly News overdoses Source Type: news

Metronidazole-induced cerebellar syndrome
3.5 out of 5 stars Metronidazole-Associated Encephalopathy. Farmakiotis D, Zeluff B. N Engl J Med 2016 Apr 14;374:1465 Full Text            Exposure to metronidazole (Flagyl) can precipitate a subacute cerebellar syndrome, typically manifested with dysarthria and ataxia, with or without cognitive impairment. This adverse effect is uncommon and little-appreciated. Although usually associated with prolonged exposure to the antibiotic for treatment of conditions such as abscesses of Clostridium difficile-associated diarrhea and occurring after total cumulative dose > 20 gm, the syndrome can occur after lower dose...
Source: The Poison Review - April 15, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical acute cerebellar syndrome encephalopathy metronidazole miri neurotoxicity Source Type: news

Vasculitis after snorting cocaine contaminated with levamisole
Lawrence et al. Allergy Rhinol (Providence) 2014Copyright policy — open-access 3.5 out of 5 stars Cocaine-induced ecchymotic rash. Voore NK. Cleve Clin J Med 2016 Apr;3:252-253. Full Text Since at least 2010, a large percentage of cocaine samples seized in the United States has contained levamisole, a veterinary anti-worm medication. Levamisole had previously used in humans as an anti-helminthic and also in some chemotherapy regimens. It was withdrawn from the U.S. market in 1999 because of its association with agranulocytosis and vasculitis. It is apparently added to cocaine because it increases catecholamine release, ...
Source: The Poison Review - April 7, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical cocaine levamisole vasculitis Source Type: news

Cocaine-associated cardiotoxicity: a systematic review yields no answers
Christopher Siesarchik/shutterstock.com 3 out of 5 stars Treatment of cocaine cardiovascular toxicity: a systematic review. Richards JR et al. Clin Toxicol 2016 Feb 26 [Epub ahead of print] Abstract This paper is the most frustrating thing I’ve read since I force marched my way through the “Oxen of the Sun” chapter of James Joyce’s Ulysses. I must say that, despite its difficulties, the Joyce selection — with its obstetric setting and drunken medical students — was much more fun. There is considerable controversy among toxicologists, emergency physicians, and cardiologists as to the best agent...
Source: The Poison Review - April 6, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical cardiotoxicity cocaine systematic review Source Type: news

Is ketamine safe and effective in excited delirium?
Zerbor/shutterstock.com 3 out of 5 stars Ketamine as Rescue Treatment for Difficult-to-Sedate Severe Acute Behavioral Disturbance in the Emergency Department. Isbister GK et al. Ann Emerg Med 2016 Feb 10 [Epub ahead of print] Abstract Rapidly sedating a toxicology patient who presents with excited delirium is a critical — yet often difficult — action. These patients are typically difficult to control and resistant to sedation with commonly used agents such as benzodiazepines and antipsychotics. They also have high mortality rates. The key to obtaining good outcomes in these cases is prompt evaluation and support, focus...
Source: The Poison Review - March 29, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical excited delirium ketamine sedation Source Type: news

Is possible chest wall rigidity after illicit intravenous fentanyl administration clinically significant?
3 out of 5 stars Could chest wall rigidity be a factor in rapid deaths from illicit fentanyl abuse? Burns G et al. Clin Toxicol 2016 Mar 21 [Epub ahead of print] Abstract “Wooden chest syndrome” describes marked muscle rigidity — especially involving the thoracic and abdominal muscles — that is an occasional adverse effect associated with the intravenous administration of lipophilic synthetic opioids such as fentanyl. It can make ventilation difficult, and seems to be reversed by naloxone. The authors of this interesting speculative paper hypothesized that chest wall rigidity might be at least partially re...
Source: The Poison Review - March 25, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical chest wall rigidity fentanyl wooden chest Source Type: news

Ti Santi/shutterstock.com 3.5 out of 5 stars Start me up! Recurrent ventriculat tachydysrhythmias following intentional concentrated caffeine ingestion. Laskowski LK et al. Clin Toxicol 2015;53:830-833. Abstract   (Source: The Poison Review)
Source: The Poison Review - March 22, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical Source Type: news

TPR Podcast Episode #11: Google Glass and the Toxicologist
, with Dr. Peter Chai   Written by Leon Gussow MD FACMT   In this episode, Steve Aks and I talk to Dr. Peter Chai, a senior medical toxicology fellow at the University of Massachusetts in Worcester, about his research on Google Glass and its potential use as an aid to consultation on poisoned patients.     Google Glass has the potential of giving us a new perspective on telemedicine. However, the use of this device presents several problems, especially involving data security, patient privacy and HIPAA compliance.   “Google Glass” is a head-mounted computer that can both receive and transmit data. ...
Source: The Poison Review - March 19, 2016 Category: Toxicology Authors: Leon GussowThe Poison Review Tags: Podcast Source Type: news

Sunday with SMACC: Amal Mattu on Lessons Learned from The Princess Bride
As the 2016 Social Media and Critical Care (SMACC) conference fast approaches — it will take place June 13-16 in Dublin — let’s look back on one my favorite talks from last years smaccCHICAGO get together. It’s Amal Mattu reflecting on lessons important to both life and emergency medicine contained in the 1987 film The Princess Bride. As with all of Amal’s talks, it is full of wisdom and highly entertaining. To hear the talk click here, and be sure to follow along with the slides. By the way, tickets for SMACC Dublin were snapped up quickly and are completely sold out. However, two “Golden Ticke...
Source: The Poison Review - February 29, 2016 Category: Toxicology Authors: Leon Tags: Medical Amal Mattu dublin SMACC 2016 The Princess Bride Source Type: news

Shiitake happens: dermatitis from uncooked mushrooms
puttography/shutterstock.com 3.5 out of 5 stars Shiitake dermatitis: the tale of an under-recognised, undercooked fungus. McNally A et al. Med J Aust 2016 Feb 15;204:124-6 Reference   Just when you thought it was safe to go back to the farmers’ market . . . This interesting paper presents a series of 3 cases of flagellate dermatitis following consumption of raw or undercooked shiitake mushrooms. The rashes described were linear, pruritic, and papular, sparing areas such as the mid-back that could not be reached for scratching. All of these factors suggested that lesions were caused by the Koebner phenomenon. S...
Source: The Poison Review - February 20, 2016 Category: Toxicology Authors: Leon Tags: Medical flagellate dermatitis lentinan mushroom poisoning shiitake Source Type: news