CRACKCast & Physicians as Humans on CanadiEM

This episode of CRACKCast covers Chapter 158 in Rosen's Emergency Medicine, 9th Edition.

Core Questions:

1. For each of the following, describe the expected toxicity:
2. • Jequirity pea, rosary
   • Umbrella tree, Dieffenbachia, Dumb cane
   • Capsicum annum
   • Water Hemlock
   • Jimson Weed, Deadly Nightshade
   • Eucalyptus oil
   • Poinsettia
   • Oleander, Foxglove
   • Tobacco
   • Pokeweed
   • Rhododendron
   • Yew
   • Castor Beans
3. List 5 mushrooms with early onset toxicity and 3 with late onset – and describe the toxicity expected.
4. List 4 mechanism of toxicity resulting from the use of herbal medicine.
5. List 4 plants containing cardiac glycosides.
6. What is Buckthorn?

This episode of CRACKCast covers Rosen's 9th Edition Chapter 155, Antipsychotics. Continuing along the spectrum of toxicologic exposures, these agents account for a large number of presentations to emergency departments every year. Being equipped with the knowledge of how to deal with the side effects of these medications and their associated toxidromes is imperative and may help you save lives in the future.

This episode of CRACKCast covers Rosen's Chapter 154, Lithium. You will have a solid approach to lithium overdose after listening to this episode!

Core questions:

• Describe the cholinergic toxidrome from organophosphates

• Describe the clinical presentation of organophosphate toxicity.

• How is organophosphate toxicity managed?

• What are the complications of organophosphate toxicity?

• What is the difference between organophosphates and carbamates?

• What are the unique features of chlorinated hydrocarbon toxicity? What is an example of a chlorinated hydrocarbon? How are they managed?

• How do Substituted Phenols (Dinitrophenol) cause toxicity? How are they managed?

• How is toxicity from chlorophenoxy Compounds (Agent Orange) managed?

• What is expected in paraquat toxicity? and how is this managed?

• What are the toxic effects of pyrethrins and pyrethroids?

Wisecracks:

• What is aging - in relation to organophosphate toxicity?

• What is the maximum formulation of DEET in pediatrics? When should you not use DEET?

This episode of CRACKCast covers Rosen's 9th Ed Chapter 151, Iron and Heavy Metals. While often not recognized in the acute care setting, chronic toxicity from heavy metals is common and has high morbidity, especially in pediatric populations and requires careful attention to risk factors and symptomatology.

Core questions:

1. List 6 commonly abused opioids (Table 156:1)
2. Describe the opioid toxidrome (list opioid effects on Neuro, Resp, Ophtho, CV, GI, Derm)
3. List opioid preparations associated with the following presentations:

1. Long QTc →
2. Prolonged QRS →
3. Seizures →
4. Hallucinations →)
5. Sensorineural hearing loss →
6. Serotonin syndrome →

1. i) What is the dose of narcan? ii) What is the duration of action? iii) How do you administer a narcan infusion?
2. What opioid overdoses/ingestions need longer than 6 hours of observation?
3. What is the clinical presentation of opioid withdrawal?
4. What are risk factors for opioid withdrawal?
5. List 3 medications effective for opioid withdrawal.
6. What is the number one killer of people under 50?
7. What is Suboxone?
8. How do you do a Suboxone induction?

WiseCracks:

1. List 5 ddx for opioid intoxication (CNS + resp depression, + miosis).
2. What opioids don't cause miosis?
3. Risk factors for opioid overdose?
4. What is NAPE? Narcan induced pulmonary edema.
5. Difference between a "body packer" and "body stuffer"?

This episode of CRACKCast covers Rosen's Chapter 141, Toxic Alcohols. This chapter covers exposure to your stereotypical toxic alcohols (i.e., ethylene glycol and methanol) as well as the consequences of ingesting ethanol and isopropyl alcohol.

This episode of CRACKCast covers Rosen's Chapter 153, Inhaled Toxins. This chapter covers exposure to various inhalation toxins including CO, hydrogen sulfide, etc. and includes their treatment and management for acute exposures.

This episode of CRACKCast covers Rosen's 9th Ed Chapter 147, Cardiovascular Drugs. With increasingly common use of these medications for heart disease and an ever aging population, it is imperative to understand the prompt recognition and therapy for toxic exposures. Recognition of the more lethal agents and how to disposition these patients in the ED are the cornerstones of this chapter.

This episode of CRACKCast covers Rosen's 9th Edition Chapter 154, Cocaine and Other Sympathomimetics. Continuing along the spectrum of toxicologic exposures, these agents account for a large number of presentations to emergency departments every year. Having an in-dept understanding of their mechanism of action and a solid approach to the assessment and treatment of these patients is critical.