Toxicology

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 4 July 2016

⏱️ 9 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Poison Control Hotline: 1-800-222-1222

Step 1: Evaluate the Airway

* General principles* “If they can’t speak, they can’t control their airway”* “If GCS is <8, intubate”* In the real world, it’s a clinical judgement call

Step 2: Toxicology History

* What did they take? * How much did they take?* Why did they take it?* When did they take it?

Step 3: Toxicology Exam

* Vital signs* Pupils* Skin

Step 4: Medication List

* Make note of all bottles with patient* Make EXTRA note if any pills seem to be missing* Bonus points if you bring your attending a med list

Step 5: Common Toxicology Tests

* Assessing for damage* Electrolytes* Liver function test* EKG* Pregnancy* Assessing for co-ingestion* Serum acetaminophen* Serum salicylate* Serum alcohol* Urine drug screen

The “Big 5” Toxidromes

* Anticholinergic* Increased vitals* Big pupils* Dry skin* Treatment – Physostigmine (rarely given)* Cholinergic* Decreased vitals* Small pupils* Moist skin* Treatment – Atropine* Opioid* Decreased vitals* Small pupils* Dry skin* Treatment – Naloxone* Sedative/Hypnotic* Decreased vitals* Normal pupils* Dry skin* Treatment – Flumazenil (rarely given)* Sympathomimetics* Increased vitals* Big pupils* Moist skin* Treatment – Benzodiazepines

Additional Reading

* NBME Shelf Review – Ophthalmology and Toxicology (EM Clerkship)* Toxidromes (Admin EM)

Transcript

Click on a timestamp to play from that location

0:00.0	Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of
0:07.1	endless charting once you become a doctor? Do you think that doctors should be spending more
0:11.9	time with our patients and less time mindlessly writing notes? Freed AI is the product for you. It is a
0:20.4	secure, hippocompliant scribe that anybody can use.
0:24.7	Focus your energy on what matters, providing good patient care.
0:29.5	Use coupon code EM50 to save 50% the first month you try it,
0:34.1	and you can cancel at any time if you decide it's not right for you. You can learn more
0:38.9	at www.gitfreed.a.i. Hello, med students. My name is Zach Olson. Thank you for downloading this
0:49.9	episode of the EM Clerkship Podcast. I want you to close your eyes and imagine. In front of you
0:56.6	is a 40-year-old female. She's being wheeled in by EMS with severe altered mental status.
1:04.0	Her blood sugar is normal, but they do report that the patient had several empty pill bottles nearby.
1:10.4	Pause here.
1:11.6	What is your next step?
1:18.5	Today, we're going to cover toxicology.
1:22.6	This episode's actually going to be broken down into two parts.
1:26.3	The first part is the quick approach to any toxicology case.
1:30.6	And then in part two, I'm going to go through the big five toxodromes as laid out in Tintanallies.
1:36.8	So this is going to be a pretty intense episode.
1:38.9	I need you guys to hang with me today.
1:40.9	The thing that I'm going to want you to remember from this episode is that you have to look
1:45.7	at the patient's vitals, pupils, and skin. Vital's pupils skin. We're going to go into that more
1:51.6	in a bit, but let's just start out with our basic approach. Step one, airway. Just like with trauma,
	...

Please login to see the full transcript.

Previous episode | Next episode

Disclaimer: The podcast and artwork embedded on this page are from Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.