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The ABCDEFG of tox-caused bradycardia Alpha-2 agonists (e.g. clonidine) Beta-blocker Calcium channel blocker Digitalis ETOH Fentanyl and other opiates Gardening (pesticides with organophosphates)
(Click the link to comment and to vote – voting not working through email, sorry!) Three female high school basketball players and two male scorekeepers entered the school gym before all other students. Soon after entering, all 5 began to… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) Ketamine has been in the news lately, contributing to the death of actor Matthew Perry and playing a part in the recent successful prosecution of… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A teen living in a state where abortion is newly outlawed ingests something that she has read online is an abortifacient. She presents to the… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) A 10 year boy was out hiking with his family, several feet ahead of everyone else. He heard a rattle, felt a sharp pain in… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Parents bring in a 3 year old child that drank a few sips of household bleach which had been stored by grandparents in an empty… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 19 year old male who has had several ED visits for abdominal pain, nausea and vomiting. He insists that he does… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 15 year old who took a handful of aspirin in a suicide attempt. The salicylate level at 3 hours post-ingestion is… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) As part of the work-up for abnormal behavior in a 3 year old, the qualitative urine drug screen comes back positive for a substance.
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 15yo patient with past psychiatric history who takes escitalopram (Lexapro) and quetiapine (Seroquel) for nausea and vomiting. You give the patient… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 15yo obese patient is brought in after admitting to taking an overdose of “a handful” of metformin as a suicide attempt. No other drugs… Continue Reading →
A 16yo patient is brought in directly from a large “pharm” party with altered mental status, respiratory depression, and pinpoint pupils. You suspect opiate overdose and administer naloxone with improvement in spontaneous respirations. To your surprise, however, the qualitative urine… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A toddler, visiting for the holidays, has been roaming his grandmother’s large backyard, nibbling on plants.
There is surprisingly sparse literature to help determine how much a child swallowed as part of a toxic ingestion. Most texts quote the work of Jones & Work in Am J Dis Child 1961, who studied 10 children aged 1.25-3.5… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) An adolescent is brought in intoxicated with history of drinking large amounts of alcohol at a dorm party. He vomited multiple times at the scene… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) At a New Year’s Eve party several glasses of champagne are left lying around the house. The family’s 2yo toddler proceeds to drink some of… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) A 13yo boy comes in by ambulance after a syncopal episode. He and his friends heard that vaping is dangerous, so they used a hookah… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 17yo boy with cough x 1 month. You prescribe Tessalon Perles (benzonatate). He has a 2yo sibling at home.
With the rise in legality of cannabis products, ED (and even PED) clinicians are seeing a big rise in cannabis hyperemesis syndrome. Topical capsaicin 0.025-0.075% is a known reliever of symptoms, as outlined on AliEM here. But who stocks topical… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a child with suspected methemoglobinemia from overuse of benzocaine teething gel. You plan to treat with methylene blue. Which of the following… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a pair of 14 year old girls who took “Triple C” at a party. One is altered and the other is hallucinating…. Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A toddler is brought in to the ED after it is suspected that he ate his uncle’s brownie containing cannabis.
(Click the link to comment and to vote – voting not working through email, sorry!) Regarding common Christmas holiday plants:
Hyperemesis due to cannabis use is on the rise, particularly in areas with marijuana legalization. While classically it is seen in chronic, daily users, affected patients sometimes have been using cannabis for less than a year, and may be using… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 2yo child is brought in after having taken some of Grandma’s “heart medicine.” Because the pills are kept in an unlabeled box and not… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 14 month old is brought in with lethargy and obtundation. The patient is breathing spontaneously and has stable vital signs. The parents admit that… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) An 8 year old boy presents after taking 3-4 of grandma’s pills about an hour prior. It is unknown what Grandma takes, but she has… Continue Reading →
Use the PATCH mnemonic to remember transdermal medications Child with unusual symptoms, potential toxidrome? Look all over their body for a medication patch. Many are transparent or look like bandaids. P Pain (fentanyl, lidocaine) A Anti-cholinergic (scopolamine) T… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Several members of a family present to the cruise ship infirmary of an Alaskan cruise. They just ate a lunch consisting of tuna salad sandwiches…. Continue Reading →
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A 19yo man presents with his 3rd bout of unremitting nausea and vomiting. He has been admitted twice before and treated with ondansetron and IV fluids. He was noted to take frequent long showers while admitted. (Click the link to… Continue Reading →
A 19yo man presents with progressively worsening extremity numbness in a glove and stocking distribution and ataxia x 1 month. He has areflexia, weakness, and a wide-based gait on exam. (Click the link to comment and to vote – voting… Continue Reading →
A 16yo boy just returned from a vacation to the U.S. Virgin Islands. On the flight, he developed abdominal pain, nausea, vomiting, which he initially attributed to airsickness. He came straight from the airport to the ED, and now he… Continue Reading →
A 6yo child is brought in after rescue from a housefire. He is unconscious, and has soot in his nares. You perform rapid sequence intubation. Vital signs are: Temp 37.5, HR 120, BP 68/40, O2 saturation 100%. You note a… Continue Reading →
All of the following preclude expectant outpatient management in the case of an ingested button battery found by imaging to be in the stomach except: A. Co-ingestion of a magnet B. Child complains of abdominal pain C. Child has history… Continue Reading →
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