A 74 year old male presents to the Emergency Department with altered mental status. Family reports decreased intake over the past few days. She takes Digoxin for CHF. Her bllood pressure is 78/42 and her HR is 48. Her creatinine is 3.7, K 6.0, serum digoxin level is pending. What is the most appropriate initial therapy for this patient?
“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:
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!