Contributors: Travis Barlock MD, Ian Gillman PA, Jacob Altholz MD, Jeffrey Olson MS4

In this episode, EM attending Travis Barlock and medical student Jeffrey Olson listen in to the two remaining cases presented from EMM's recent event, Tox Talk 2025.

Talk 1- Methemoglobinemia- Ian Gillman

• Cyanosis + chocolate-colored blood + normal PaO₂ + pulse ox stuck at ~85% = Methemoglobinemia → Treat with methylene blue

• The medications that can cause it can be remembered with…

• Watch out with methylene blue as it can cause serotonin syndrome

• While treating with methylene blue the pulse ox can drop dramatically but this is not a real drop in oxygenation but rather an effect of how the methylene blue affects the sensor

• BADNAPS: causes of methemoglobinemia

• Benzocaine

• Aniline Dyes

• Dapsone

• Nitrites/Nitrates (Found in meds, preservatives, and well water)

• Antimalarials

• Pyridium

• Sulfonamides

Talk 2- Intratecal TXA and Hierarchy of Controls for Error Avoidance - Jacob Altholz

• Hierarchy of Controls in terms of error prevention includes all of the layers of protection which can be categorized as elimination, substitution, engineering controls, administration controls, and PPE

References

• Centers for Disease Control and Prevention. (2022, April 28). Hierarchy of controls. National Institute for Occupational Safety and Health. https://www.cdc.gov/niosh/learning/safetyculturehc/module-3/2.html

• Pushparajah Mak RS, Liebelt EL. Methylene Blue: An Antidote for Methemoglobinemia and Beyond. Pediatr Emerg Care. 2021 Sep 1;37(9):474-477. doi: 10.1097/PEC.0000000000002526. PMID: 34463662.

Produced by Jeffrey Olson, MS4

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