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ACMT Toxicology Visual Pearls: On the Mark

ALiEM

Note that succinylcholine is contraindicated as it is metabolized by plasma pseudocholinesterase. 2019 Aug;9(4):337-342. 2019 Oct;123(4):457-463. Epub 2019 Jun 24. Use benzodiazepines such as diazepam or midazolam for seizures. Provide supportive care. The patient will likely require intubation. Chemical terrorism.

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Anti-NMDA Receptor Encephalitis in Children and Adolescents

Pediatric EM Morsels

It is commonly missed during the first few ED visits. First line therapies for anti-NMBDA receptor encephalitis consists of… High dose steroids , IVIG, and PLEX – Therapeutic plasma exchange Only 50% of patient’s respond, and will require second line therapies such as Rituximab. Epub 2019 Dec 19. 2020 Feb;75:55-62.

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Anticoagulation Reversal

Core EM

Published 2019 Jun 6. Background Around 6 million people in the U.S. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Background Around 6 million people in the U.S. Clin Med (Lond).

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Transfusion Reactions

Core EM

In: Marx J, ed. In: Wolfson A, ed. Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3%

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Congenital Syphilis

Pediatric EM Morsels

2019, there were 1,875 and this trend has continued to increase (2,157 case in 2020; 2,855 cases in 2021). Congenital Syphilis may still occur in patients presenting to your ED! Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Hussain, 2023 ] Leads to >300,000 perinatal deaths / year globally.

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Trauma Resuscitation Updates

REBEL EM

JAMA 2015 [7] The PROPPR Trial 680 severely injured adult trauma patients Patients randomized to Plasma, Platelets, and PRBCs in a 1:1:1 ratio vs 1:1:2 ratio No difference in overall mortality at 24 hrs BUT 1:1:1 achieved hemostasis faster and fewer experienced death due to exsanguination at 24hrs Crombie N et al.

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ToxCard: Local Anesthetic Systemic Toxicity

EMDocs

These medications are a vital tool in the care of ED patients, from simple local analgesia for a laceration repair to regional analgesia for painful procedures. Metabolism of ester anesthetics is by plasma cholinesterase, whereas amides are metabolized by the cytochrome P450 system in the liver. [6] McGraw Hill Companies, Inc; 2019.

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