Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Toxicology Images

Steve Walsh, MD

Here are some of the fun toxicology facts from the images shown during lecture:

  • Envenomations by sea creatures with spines are treated with hot water immersion of the envenomated body part, removal of foreign body, tetanus booster, and empiric antibiotic coverage (fluoroquinolones for Vibrio and Pseudomonas spp.)
  • Strychnine toxicity is characterized by “awake seizures” (mental status is intact despite generalized muscle rigidity that can be mistaken for seizure), and is best treated with early intubation and neuromuscular blockade to prevent life-threatening acidemia, respiratory failure, and rhabdomyolysis.
  • The “magic number” for acetaminophen toxicity is 150. 150 mg/kg is thought to be the toxic dose, 150 is the toxic [APAP] at 4h, and IV NAC (Acetadote) is loaded at 150 mg/kg over one hour.
  • Bidirectional ventricular tachycardia is very uncommon in but the pathognomonic rhythm of cardiac glycoside (i.e., digoxin) toxicity. If you see it, there’s essentially nothing else in the world (toxic or otherwise) that can cause this EKG finding.


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