This is EM cases, EM Quick Hits podcast, where our team of experts and educators bringing clear, concise, and condensed, practice-changing knowledge on all those EM topics you may not be totally comfortable with. Cases, the latest evidence, concise, and condensed practice-changing knowledge on all those EM topics you may not

be totally comfortable with. Cases, the latest evidence, procedural tips and tricks,

pitfalls to avoid, and the key take-home points and references on the EM cases website.

Quick, let's get on with it.

First up, we've got Dr. Emily Austin, our toxicology guru, and she's going to tell you that

fizo stigmine is back. We used to avoid it like the plague back in the day, but as Dr. Austin

will explain, it's actually pretty safe and effective for those patients who come in blind as a bat,

dry as a bone, full as a flask, hot as a hair, red as a beat,

and mad as a hatter who have normal intervals on their ECG.

Consider this recent case.

A 17-year-old male is brought into the emergency department with what very much sounds like an

antichcholinergic toxidrome.

He's tachycardic at 140, hyperthermic at 382, his blood pressure is 160 on 85.

He's clearly having visual hallucinations, occasionally addressing the wall and picking at the air.

He's slightly startled and agitated. There's essentially no history available. His mother says that she last saw him

well at home about four hours before, but then heard some loud noises in his room. An ECG shows sinus

tachycardia with a normal QRS and QTC. All blood work done is normal. Progressively, he gets more

altered. He keeps trying to climb out of his stretcher,

and for his safety, the ED team has placed him in soft restraints. Despite this, he's fighting

and much more agitated. It's clear that you need to give him sedation, but ideally,

you'd rather not sedate him so much that he requires either excessive monitoring or even intubation and then transfer

to a piccue. You're asking yourself, isn't there an antidote for the antich colonergic

...