Toxicology Archives - The Western Journal of Emergency Medicine

Characterization of Regional Poison Center Utilization Through Geospatial Mapping

Olives, TD.

Penetrance is the annual rate of human exposure calls per 1000 persons, a measure that historically describes poison center (PC) utilization. Penetrance varies by sociodemographic characteristics and by geography. Our goal in this study was to characterize the geospatial distribution of PC calls and describe the contribution of geospatial mapping to the understanding of PC utilization.

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Response to: “Management of Chloroquine and Hydroxychloroquine Poisoning: Do Not Miss the Time of Tracheal Intubation and Mechanical Ventilation”

Lebin, JA.

We thank Drs. Megarbane and Schicchi for their thoughtful comments on our manuscript and efforts to highlight pertinent in vitro and in vivo literature. As stated in our manuscript, we agree that aggressive supportive care is the mainstay of treatment for acute chloroquine and hydroxychloroquine toxicity, including management of the airway with appropriate ventilation, if necessary.

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Management of Chloroquine and Hydroxychloroquine Poisoning: Do Not Miss the Time of Tracheal Intubation and Mechanical Ventilation

Megarbane, B.

We would like to comment on Lebin and LeSaint’s overview of chloroquine/hydroxychloroquine (CQ/HoCQ) toxicity and management.1 The authors focused on the indications and administration modalities of hypertonic sodium bicarbonate, diazepam, and epinephrine. Surprisingly, they did not consider the role and indications of tracheal intubation and mechanical ventilation, while representing the mainstay of treatment.

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Telephonic Medical Toxicology Service in a Low-Resource Setting: Setup, Challenges, and Opportunities

Hitti, E.

Poisoning and envenomation are a global health problem for which the mortality burden is shouldered heavily by middle- and low-income countries that often lack poison prevention programs and medical toxicology expertise. Although telehealth or teleconsult services have been used to bridge the expertise gap between countries for multiple specialties, the use of medical toxicology teleconsult services across borders has been limited. We aim to describe the use of a United States-based medical toxicology teleconsult service to support patient care at a hospital in a middle-income country that lacks this expertise. This report outlines the logistics involved in setting up such a service, including the challenges and opportunities that emerged from establishing medical toxicology teleconsult service in a low-resource setting.

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Cannabis in Homes with Children: A Survey on Use, Storage, and Attitudes

Gimelli, A.

The recent legalization of cannabis in California has the potential to affect cannabis prevalence in households with children. This eventuality, combined with suboptimal cannabis storage practices, could lead to adverse effects such as unintentional pediatric ingestion, which occurred in Colorado after legalization. Our objective was to assess prevalence and storage practices of cannabis in households with children, and attitudes on use and storage education in a state that has legalized cannabis.

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Toxicologic Exposures in California Emergency Departments in 2011 and Its Risk Factors

Loftipour, S.

Toxicologic exposures (TE) are a major preventable public health issue, with most cases due to unintentional causes. Although these cases are well documented and reported via the National Poison Data System, there is little information regarding toxicologic exposure cases in the emergency department (ED). The aim of this study was to identify demographic groups at risk for potential poisoning.

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Antivenom Treatment Is Associated with Fewer Patients using Opioids after Copperhead Envenomation

Freiermuth, MD, et al.

There is rising concern that an initial opioid prescription from the emergency department (ED) can lead to long-term addiction. This analysis sought to determine whether use of Fab antivenom (FabAV) for copperhead envenomation affected opioid use.

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Availability of Bedside and Laboratory Testing for Carbon Monoxide Poisoning in the Upper Midwestern United States

Masters, MD, et al.

The objective of this study was to assess the ability to test patients for carbon monoxide (CO) exposure in all hospitals in three United States (U.S.) Midwestern states.

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Patient Preference for Pain Medication in the Emergency Department Is Associated with Non-fatal Overdose History

Whiteside, MD, MS, et al.

The purpose of this study was to determine if patient-reported preference for specific pain medications was associated with a history of lifetime overdose among patients seeking care in the emergency department (ED).

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Transaminase and Creatine Kinase Ratios for Differentiating Delayed Acetaminophen Overdose from Rhabdomyolysis

Radke, MD, et al.

Establishing the cause of elevated transaminases may be especially difficult because of limited or inaccurate histories of acetaminophen ingestion. We hypothesized that the comparative ratios of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine kinase (CK) can differentiate acetaminophen hepatotoxicity from rhabdomyolysis.

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Characterization of Chemical Suicides in the United States and Its Adverse Impact on Responders and Bystanders

Ayana R. Anderson, MPH

A suicide trend that involves mixing household chemicals to produce hydrogen sulfide or hydrogen cyanide, commonly referred to as a detergent, hydrogen sulfide, or chemical suicide is a continuing problem in the United States (U.S.). Because there is not one database responsible for tracking chemical suicides, the actual number of incidents in the U.S. is unknown. To prevent morbidity and mortality associated with chemical suicides, it is important to characterize the incidents that have occurred in the U.S.

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Emergency Physicians’ Knowledge of Cannabinoid Designer Drugs

Author Affiliation Patrick M. Lank, MD Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Elizabeth Pines, MD Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Mark B. Mycyk, MD Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois Introduction Methods Results Discussion Limitations Conclusion […]

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Parenteral Hydrocarbon Injection and Associated Toxicities: Two Case Reports

Author Affiliation Michael E. Nelson, MD, MS John H. Stroger Hospital of Cook County, Chicago, Illinois Toxikon Consortium, Illinois Poison Control Center, Chicago, Illinois Isam Nasr, MD John H. Stroger Hospital of Cook County, Chicago, Illinois Westlake Hospital, Melrose Park, Illinois Introduction Case reports Discussion Conclusion INTRODUCTION Many cases of hydrocarbon toxicity occur annually due […]

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Holiday Plants with Toxic Misconceptions

Several plants are used for their decorative effect during winter holidays. This review explores the toxic reputation and proposed management for exposures to several of those, namely poinsettia (Euphorbia pulcherrima), English holly (Ilex aquifolium), American holly (Ilex opaca), bittersweet (Solanum dulcamara), Jerusalem cherry (Solanum pseudocapsicum), American mistletoe (Phoradendron serotinum), and European mistletoe (Viscum album).

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Chemical Burn Secondary to Propofol Extravasation

A 58-year-old female presented to the emergency department (ED) with pain and swelling to the right arm after receiving propofol during an outpatient procedure for nasal polyps.

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A Pain in the Wrist: Stingray Envenomation

A 43-year-old man presented to the emergency department after he was swimming in the ocean and felt a sudden sting followed by a burning pain and muscle spasms in his right hand.

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Massive Atropine Eye Drop Ingestion Treated with High-Dose Physostigmine to Avoid Intubation

A 34-year-old male presented after ingesting 150 mg of atropine. He had altered mental status, sinus tachycardia, dry mucosa, flushed skin, and hyperthermia. Sequential doses of physostigmine, totaling 14 mg, were successful in reversing antimuscarinic toxicity and prevented the need to perform airway control with endotracheal intubation. At completion of treatment, heart rate and mental status had improved, and intubation was never performed.

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Coagulopathy: The Most Important Thing We Still Don’t Know About Snakebite

Can we define a group of pit viper victims who are at low risk for hematologic venom effects (fibrinogen degradation and/or platelet destruction) and spare these patients the time and expense of serial laboratory testing?

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The Role for Coagulation Markers in Mild Snakebite Envenomations

In this study, we sought to determine whether it was possible to limit the practice of ordering coagulation studies to those patients suffering severe envenomation, rattlesnake envenomation, or both.

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Regions Hospital Toxicology Education and Clinical Service, St Paul, Minnesota

The objective was to demonstrate the effect of a range of SBE-CD concentrations in a rat model of verapamil toxicity.

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Bath Salts: The Ivory Wave of Trouble

Bath salts pose an increasing public health risk in the United States, with reports of toxicity and mortality increasing along with calls to poison centers throughout the United States. Packages labeled with innocuous monikers such as White Ice, Ivory Wave, Ocean Snow, Lunar Wave, and Vanilla Sky intentionally belie the dangerous substances within, which are by no means intended to replace legitimate bath products.

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Cholinergic Crisis after Rodenticide Poisoning

Rodenticides have historically been common agents in attempted suicides. As most rodenticides in the United States (U.S.) are superwarfarins, these ingestions are generally managed conservatively with close monitoring for coagulopathy, and if necessary, correction of any resulting coagulopathy. However, alternate forms of rodenticides are imported illegally into the U.S. and may be ingested either accidentally or in suicide attempts. We present an unusual case of poisoning by the illegally imported rodenticide, “Tres Pasitos.”

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Cardiomyopathy Following Latrodectus Envenomation

Latrodectus envenomations are common throughout the United States and the world. While many envenomations can result in catecholamine release with resultant hypertension and tachycardia, myocarditis is very rare. We describe a case of a 22-year-old male who sustained a Latrodectus envenomation complicated by cardiomyopathy.

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Critical Care

Spectacular Retroperitoneal Impalement

A 47-year-old woman presented with a history of an accidental fall against a glass door at home, causing a 15 cm-wide wound on the right gluteal region and hematuria. General health was good: blood pressure 115/70 mmHg with a heart rate of 100 beats/min; red cell count 4.460 x103/100 mL; hemoglobin concentration 10 g/100 ml; and hematocrit 31%.

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Critical Care

Improving Diagnostic Accuracy of Anaphylaxis in the Acute Care Setting

The identification and appropriate management of those at highest risk for life-threatening anaphylaxis remains a clinical enigma. The most widely used criteria for such patients were developed in a symposium convened by National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network. In this paper we review the current literature on the diagnosis of acute allergic reactions as well as atypical presentations that clinicians should recognize. Review of case series reveals significant variability in definition and approach to this common and potentially life-threatening condition. Series on fatal cases of anaphylaxis indicate that mucocutaneous signs and symptoms occur less frequently than in milder cases. Of biomarkers studied to aid in the work-up of possible anaphylaxis, drawing blood during the initial six hours of an acute reaction for analysis of serum tryptase has been recommended in atypical cases. This can provide valuable information when a definitive diagnosis cannot be made by history and physical exam.

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Critical Care

Leukocytosis as Prognostic Indicator of Major Injury

To test the diagnostic use of the triage white blood cell (WBC) count in differentiating major from minor injuries.

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