Toxicology

A 42-year-old female with a past medical history of iron deficiency anemia presents to the ED with a peritonsillar abscess. You give 2 benzocaine sprays and successfully aspirate the abscess. As she is waiting for her discharge paperwork, the nurse alerts you that her oxygen saturation is now in the mid-80s. Repeat vitals in the room are as follows: BP 102/78, HR 102, O2 85%, RR 24. She has perioral cyanosis that was not seen on your initial exam. What is the diagnosis and best next step?

Paraquat is a herbicide that is rapidly absorbed and undergoes redox-cycling with generation of ROS causing cellular dysfunction and death. Tolerate hypoxia and avoid oxygen as it can promote oxidative stress and causes further tissue damage.

Chasing the Dragon refers to the practice of heroin inhalation by placing heroin in a small square of aluminum foil which is then heated from below. As the heroin melts it turns into a reddish-brown substance that may resemble a dragon’s tail. Inhaling heroin may induce toxic leukoencephalopathy, which has no proven treatment and recovery, if any, is prolonged.

What’s cotton fever and its mechanism of action? How should you manage a patient you suspect is suffering from cotton fever?

Diquat is a bipyridyl compound used as an herbicide and is a rare form of poisoning. Diagnosis is made by history and urine sodium dithionite test with green coloration (dose related color intensity) of the urine.

Today on the emDocs cast we cover pediatric toxicology and one pill/taste can kill toxins.

How can you remember radiopaque toxins on radiography? Heard of COINS?

What role does phenobarbital have in treatment of alcohol withdrawal?

In recent weeks many law enforcement agencies around the country have used some form of tear gas against protesting civilians, resulting in the most widespread domestic use of riot control agents against civilians since the period of unrest of the ’60s and ’70s. Healthcare responders need to be aware of proper decontamination and initial supportive care when dealing with these agents.

NMDA encephalitis is challenging to diagnose in the ED, but a little knowledge can go a long way. This ToxCard provides pearls in the evaluation and management of NMDA encephalitis.