Dr. Sergey Motov delivered a highly educational grand rounds on Acute Pain Management in the ED.  Read ahead for some pearls and teaching points from his high yield talk...  

Who is Tim and what is the deal with his hands?!?! Read on below for a review of the differential diagnosis of patients who present altered found to be hyperthermic.

Carbon Monoxide Poisoning 

“Airway cart to 9A. Intern, this tube is yours. What meds do you want?”

After the initial self-pulse check and change of scrub pants, two words come to mind: SOAP ME. Not in the literal sense, which may or may not be necessary depending on how nervous one is, but in the handy-dandy-easy-to-remember-in-high-pressure-situations-mnemonic sense. The deer-in-headlights (AKA intern-in-headlights look aside), this edition aims to take a look into an expected adverse reaction with a commonly used rapid sequence intubation (RSI) medication: hyperkalemia associated with succinylcholine administration.

• Digitalis inactivates the Na-K-ATPase pump to increase intracellular calcium and extracellular potassium, causing + inoptropy, hence usage in CHF patients
• Dig also increases vagal tone and decreases conduction through the AV node, hence usage in atrial fibrillation. In toxic doses, this is what leads to bradydysrhythmias

Toxicity can either be Acute or Chronic:

Altered mental status in a patient with a history of depression...

To wrap up our toxicology module, Dr. Sumaya Mekkaoui reviewed serotonin syndrome.  This can be a challenging diagnosis to make and is often misinterpreted as other psychiatric or medical syndrome.  Look ahead for a quick review on the  clinical presentation, drugs implicated in serotonin syndrome, and comparing/contrasting similar toxidromes.  

The Urine Drug Screen (UDS) is a commonly used test in the emergency department, however there are many shortcomings that limit its diagnostic utility. The Urine Drug Screen is exactly that – a SCREENing and not a confirmatory test!  This week Dr. Lauren Murphy educated us on: 1) the potential false positives and negatives of the UDAS and 2) the detection times that drug metabolites are at a concentration in the urine to trigger a positive result (cutoff value).  Read ahead for the reference tables!    

Your patient just ate fish and seems to be having a weird reaction.  Could this be one of those weird marine poisonings?

After the awesome RESUS/EM conference last week, we return to our module of the month: Toxicology.  This week Dr. Lauren Murphy has summarized the key points of her talk on the toxic alcohols.  Knowing a little bit about toxic alcohol ingestion is very useful, as it is a fatal toxicity but treatable when recognized in a timely manner!