ALiEM

FEBRUARY 5, 2024

After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to toxicology in the Emergency Department. More specifically, we identified 3 AIR and 5 Honorable Mentions.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

ALiEM

NOVEMBER 29, 2023

Recently, xylazine has gained attention in the media with increasing reports of xylazine-related overdose deaths in patients. When combined with illicit opioids such as heroin and fentanyl, xylazine may increase the risk of fatal overdose given the augmented sedation and respiratory depression effects [2]. Published May 2023.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

EMergucate

APRIL 11, 2022

20 year old epileptic woman presented to the emergency department after polypharmacy overdose. Her VBG showed the following: PH = … Continue reading →

Overdose 100

Overdose Emergency Department 100

EMergucate

OCTOBER 2, 2022

A young man with history of asthma, presented to the emergency department after taking an overdose of his asthma medication. … Continue reading →

Overdose 100

Overdose Emergency Department 100

Pediatric EM Morsels

OCTOBER 27, 2023

Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. The PAWPER tape as a tool for rapid weight assessment in a Paediatric Emergency Department: Validation study and comparison with parents’ estimation and Broselow tape. Int J Emerg Med.

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

ACEP Now

JULY 7, 2023

Emergency departments (EDs) focus on rapid initiation of medical treatment. Patients with opiate overdose get naloxone. References American College of Emergency Physicians Clinical Policies Subcommittee on the Adult Psychiatric P, Nazarian DJ, Broder JS, et al. Ann Emerg Med. West J Emerg Med. Ann Emerg Med.

Emergency Department 52

Emergency Department ED Naloxone ALS 52

ACEP Now

JULY 7, 2023

CASE A 30-year-old woman presents to the emergency department with left arm pain from a chronic wound. Xylazine is a veterinary sedative that has been increasingly implicated in overdose deaths throughout the United States. percent of all overdose deaths in 2020. She reports fevers up to 103 degrees Fahrenheit.

Overdose 98

Overdose ALS Naloxone Emergency Department 98

REBEL EM

JUNE 5, 2023

Background Information: Opioid overdose deaths have been increasing in the past twenty years. The national number of overdose deaths from any opioid has increased 62.5% In addition, buprenorphine has a lower risk of death from overdose when compared to methadone (2). PMID 33392580. Characteristics: Mean age 35.5 Homeless: 32.6%

Naloxone 88

Naloxone ED Overdose Emergency Department 88

Core EM

JULY 23, 2024

The Case An elderly male with a past medical history of hypertension and diabetes presents to the emergency department with a chief complaint of diarrhea and shortness of breath. His vital signs are: HR 60, BP 105/65, RR 30, O2 100% on room air, oral T 98.6 F, and FSG 120. His only medications were lisinopril and metformin.

Plasma 130

Plasma Emergency Department Overdose OR 130

FOAMfrat

DECEMBER 26, 2024

IF YOU OR A LOVED ONE NEEDS HELP, CALL 988 OR SEEK CARE AT A LOCAL EMERGENCY DEPARTMENT. Unlike other methods, such as firearms, hangings, intentional overdoses, and cutting, chemical suicides tend to linger in the area where the act was committed. TRIGGER WARNING: TOPICS OF SUICIDE MAY BE HARD FOR SOME PEOPLE TO READ ABOUT.

Epinephrine 116

Epinephrine First Responder OR Emergency Manager 116

Core EM

JANUARY 24, 2024

The Case An elderly male with a past medical history of hypertension and diabetes presents to the emergency department with a chief complaint of diarrhea and shortness of breath. His vital signs are: HR 60, BP 105/65, RR 30, O2 100% on room air, oral T 98.6 F, and FSG 120. His only medications were lisinopril and metformin.

Plasma 130

Plasma Emergency Department Overdose OR 130

EMDocs

JANUARY 17, 2024

She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). What are the treatment options for a benzonatate overdose? Management: The mainstay of treatment of benzonatate overdose is supportive and symptomatic care.

E-9-1-1 84

E-9-1-1 Overdose Emergency Medical Services Life Support 84

EMDocs

JUNE 2, 2023

Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry. Erratum in: West J Emerg Med. Pediatric Agitation in the Emergency Department: A Survey of Pediatric Emergency Care Coordinators.

Emergency Department 88

Emergency Department Emergency Medical Services Overdose ED 88

EMDocs

FEBRUARY 15, 2024

8 However, it is not considered first line in treatment of anticholinergic toxicity and is not available in all emergency departments. Use of a physostigmine continuous infusion for the treatment of severe and recurrent antimuscarinic toxicity in a mixed drug overdose. Goldfrank’s Toxicologic Emergencies, 11e.

E-9-1-1 109

E-9-1-1 Overdose ED OR 109

ACEP Now

MAY 8, 2023

1,2 With such enormous popularity it is no surprise that each year there are 56,000 emergency department (ED) visits, 2,600 hospitalizations, and 500 deaths in the U.S. 1,2 With such enormous popularity it is no surprise that each year there are 56,000 emergency department (ED) visits, 2,600 hospitalizations, and 500 deaths in the U.S.

Overdose 52

Overdose ALS OR EMS 52

EM Literature of Note

MARCH 2, 2023

First, and not least, the Annals of Emergency Medicine Podcast , the Ryan and Rory Show, recapping the articles from each month’s issue, available for free on your choice of streaming platforms: Apple Podcasts Google Podcasts Soundcloud Then, there’s always something to learn from ACEP Now!

Overdose 52

Overdose Emergency Department EMS 52

REBEL EM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. appeared first on REBEL EM - Emergency Medicine Blog. Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2; 95% CI -1.4

ED 93

ED ICU Emergency Department Overdose 93

EMDocs

SEPTEMBER 7, 2023

Elimination half-life data is not well established but increases in larger overdoses and as renal injury begins to occur. 2 Laboratory assays for DEG are not widely available and have long turn-around-times, thus have limited utility in diagnosis in the emergency department. Metabolism of DEG adapted from Bessenhofer, et al.

E-9-1-1 87

E-9-1-1 ALS Plasma Emergency Department 87

ACEP Now

JANUARY 5, 2025

The PREOXI trial compared oxygen mask pre-oxygenation versus noninvasive positive-pressure ventilation (NIPPV) in patients requiring intubation in emergency departments (EDs) and intensive care units. Effectiveness of direct admission compared to admission through the emergency department: a stepped-wedge cluster-randomized trial.

ALS 40

ALS E-9-1-1 ED Emergency Department 40

EMDocs

JUNE 5, 2024

Negative anion gap and elevated osmolar gap due to lithium overdose. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Recommendations for the Use of Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department. Can Med Assoc J. 2007;176(7):921-923. doi:10.1503/cmaj.061057

Overdose 97

Overdose ALS OR Emergency Department 97

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Am J Emerg Med. 1996;40(3):483-485. Accidental hypothermia.

Defibrillator 106

Defibrillator CPR Epinephrine Life Support 106

Handtevy

AUGUST 25, 2022

Background: Ketamine, developed in 1962, has been widely used for pediatric sedation in emergency departments before painful procedures. Overdoses do occur when using the IV form. It is effective in treating chronic pain conditions like sickle cell disease. What are our takeaways? Frawley, J., Sandoval, S.,

Overdose 52

Overdose EMS Emergency Department Ambulance 52

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergency department after an episode of syncope while standing in line at a grocery store. Written by Sean Trostel MD, peer reviewed by Meyers, Smith, Grauer, etc. He did not have chest pain. Is it STEMI?

Overdose 125

Overdose ACS OR ICU 125

NAEMSP

APRIL 19, 2023

Calcium is also frequently used in the treatment of hyperkalemia, calcium channel blocker overdose, hypermagnesemia, and hypocalcemia and may be more likely to be used when one of these diagnoses is the suspected cause of cardiac arrest. Turkish Journal of Emergency Medicine, 22 , 67-74. References: 1. Ramazan, K., S., & Basar, C.

E-9-1-1 52

E-9-1-1 Advanced Life Support Overdose CPR 52

REBEL EM

MARCH 13, 2024

This was not a Code 3 respiratory distress, fentanyl overdose with minimal response to Narcan or even an unconscious stroke patient with the blood pressure of a giraffe. In hindsight, I was not 100% certain, but relaying on my years of training, the voice inside my head and the gnawing feeling in my cut, it felt like the right thing to do.

NARCAN 58

NARCAN Overdose Emergency Department EMS 58

EMDocs

JULY 30, 2024

3 When administered early after overdose, nicotinamide may decrease the severity of toxicity. The father reported the patient was in his usual state of health approximately two hours ago. Activated charcoal can be used to prevent absorption in acute ingestions, presenting within an hour of exposure.

Overdose 72

Overdose ED Emergency Department OR 72

NCOAE

NOVEMBER 13, 2021

Basic anatomy and physiology, what causes common diseases like diabetes and asthma, and how to treat emergencies associated with them. Depending on the state, EMTs are authorized to administer 10 to 20 different medications, including epinephrine for an anaphylactic reaction, narcan for an overdose, or albuterol for an asthma attack.

EMT 52

EMT EMT Emergency Medical Technician Ambulance Driver 52

NCOAE

MARCH 8, 2021

On the other hand, you could be called in to attend to the victim of a car accident or a shooting or a heart attack, drowning, mountaineering accident, or drug overdose. You may even have to deliver a baby! You can never predict what will happen over the course of any given shift. Do You Have What It Takes to Become an EMT?

EMT 52

EMT EMT Emergency Medical Technician AEMT 52

EMDocs

JANUARY 4, 2024

Questions: What are the clinical manifestations of bupropion overdose? How is bupropion overdose treated? How long should a patient be observed after a bupropion overdose? 1 In addition to intentional overdoses, there are multiple case studies of abuse (ingestion, insufflation, injection). hours, SR 3 hours, XL 5 hours.

Overdose 87

Overdose E-9-1-1 ALS Emergency Department 87

Don't Forget the Bubbles

SEPTEMBER 6, 2023

14-year-old Katy presents to the paediatric Emergency Department (ED), alone, complaining of suicidal ideation. A 2023 Quality Improvement (QI) project involved the introduction of a medical clearance algorithm for children presenting with psychiatric emergencies. Acad Emerg Med. Ann Emerg Med. Ann Gen Psychiatry.

Emergency Department 119

Emergency Department ED ALS Overdose 119

The Skeptics' Guide to EM

AUGUST 18, 2018

Prospective Validation of Clinical Criteria to Identify Emergency Department Patients at High Risk for Adverse Drug Events. Guest Skeptic: Dr. Chris Bond is an emergency physician and clinical lecturer at the University of Calgary. [display_podcast] Date: August 16th, 2018 Reference: Hohl C et al. AEM Aug 2018. AEM Aug 2018.

Emergency Department 130

Emergency Department Overdose ED ALS 130

Pediatric EM Morsels

SEPTEMBER 1, 2023

One such vital aspect of pediatric emergency medicine is the appreciation of how psychosocial history impacts a patient’s life and care. As previously mentioned by Dr. Richardson , adolescents use the Emergency Department as their Primary Care resource often. This is particularly true for vulnerable adolescents.

ED 164

ED Emergency Department Overdose ALS 164

International Journal of Paramedicine

OCTOBER 12, 2023

Background: Frequent callers of emergency medical services comprise a disproportionate percentage of emergency department visits. This study aims to describe reasons for calling 911 and healthcare services among frequent callers in Ontario. Methods: Cross-sectional research design.

Overdose 52

Overdose EMS Emergency Medical Services Ambulance 52

EMDocs

DECEMBER 16, 2023

An 18-month-old boy presents to the emergency department with loss of consciousness. Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. Temps greater than 41.5C

EMS 90

EMS Heatstroke Emergency Department First Aid 90

REBEL EM

DECEMBER 19, 2022

The fragility index of these findings found to be 1 for VC and 9 for DED Obtaining a second defibrillator in the emergency department or intensive care unit can be very easy to do. It’s difficult to definitively say which of the two is statistically better, however there is a trend pointing toward DED.

Defibrillator 52

Defibrillator Paramedic CPR EMS 52

The Skeptics' Guide to EM

DECEMBER 28, 2024

Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. She is anAssistant Professor and Director of Research in theDepartment of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. Date: December 26, 2024 Reference: Steinhauser S et al.

Emergency Department 222

Emergency Department Overdose ED ALS 222

ALiEM

JANUARY 6, 2025

The pain worsened today, prompting him to come to the emergency department for evaluation. Necrotizing fasciitis Case Question: Will naloxone reverse a xylazine overdose? Thus, Narcan is reasonable to administer in the setting of a suspected overdose since the patients presentation can be due to combined use.

NARCAN 141

NARCAN Overdose Naloxone Emergency Department 141