Toxicology

Simulation, Toxicology

Ethylene Glycol Ingestion

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By the conclusion of the simulation session, learners will be able to: 1) obtain a thorough toxicologic history, including intent, timing, volume/amount, and assessment for co-ingestions, 2) distinguish the variable clinical signs and symptoms associated with toxic alcohol ingestions, 3) identify metabolic derangements associated with toxic alcohol ingestions, 4) discuss the management of toxic alcohol ingestion, 5) appropriately disposition the patient for admission to intensive care unit (ICU).

Toxicology, Certifying Exam Cases

Iron Overdose

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By the end of this oral boards case, learners will: 1) demonstrate evaluation of a patient presenting with toxic ingestion, including obtaining pertinent history, 2) review the signs and symptoms of the different presenting phases of acute iron ingestion, and 3) demonstrate appropriate treatment of iron overdose, namely, iron chelation therapy with deferoxamine.

Cardiology/Vascular, Simulation, Toxicology

Cocaine-induced Myocardial Infarction and Pulmonary Edema

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By the end of this simulation session, the learners will be able to:1) Determine appropriate diagnostics in a patient with likely cocaine toxicity. 2) Identify and manage respiratory failure.  3) Identify and manage a ST-elevation myocardial infarction (STEMI) and pulmonary edema. 4) Identify and manage cocaine toxicity with benzodiazepines. 5) Determine appropriate disposition of the patient to the cardiac catheterization lab and an intensive care unit (ICU). 6) Demonstrate effective communication and teamwork during resuscitation of a critically ill patient.

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Toxicology, Visual EM

Propafenone Overdose-induced Arrhythmia and Subsequent Correction After Administration of Sodium Bicarbonate

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The first ECG in this case showed sinus tachycardia with a widened QRS (black arrow), a rightward axis, prolonged corrected QT interval (QTc), and terminal R wave in AVR (white arrow). There are several potential causes for these ECG findings, but put together with the patient’s history, we were suspicious of sodium channel blockers being the most likely cause. The second ECG, after sodium bicarbonate was administered, demonstrated a normal QRS (black arrow) and no rightward axis deviation, reduction of the QTC and resolution of the terminal R wave (white arrow).  We later learned that the patient’s cardiologist recently increased her propafenone dose.

Toxicology, Small Group Learning

The Toxiscape Hunt: An Escape Room-Scavenger Hunt for Toxicology Education

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By the end of the activity, learners should be able to: 1) Calculate an anion and osmolal gap. 2) Recognize poisonings amenable to hemodialysis. 3) Interpret EKG changes related to a variety of ingestions, including beta-blockers and calcium channel blockers, digitalis, and tricyclic antidepressants. 4) Recognize poisonous plants and their clinical toxidromes. 5) Calculate loading dose of N-acetylcysteine as antidote for acute acetaminophen ingestion. 6) Collaborate as a team to arrive at solutions of problems. 7) Recognize poisons that have available antidotes 8) Know the clinical effect of various types of snake envenomations. 9) Recognize the toxicity associated with at least four household chemicals. 10) Know the antidotes for six common poisonings.

Team Based Learning (TBL), Renal/Electrolytes, Toxicology

Hemodialysis in the Poisoned Patient

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By the end of this cTBL, the learner will: 1) recognize laboratory abnormalities related to toxic alcohol ingestion; 2) calculate an anion gap and osmolal gap; 3) know the characteristics of drugs that are good candidates for HD; 4) discuss the management of patients with toxic alcohol ingestions; 5) discuss the management of patients with salicylate overdose; 6) know the indications for HD in patients with overdoses of antiepileptic drugs; 7) discuss the management of patients with lithium toxicity.

Toxicology, Board Review, Certifying Exam Cases

Carbon Monoxide Poisoning

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By completing this oral board case learners will 1) evaluate a patient with altered mental status and discuss the differential diagnosis of a patient with altered mental status and weakness; 2) recognize the signs and symptoms of carbon monoxide poisoning; 3) manage treatment of a patient with carbon monoxide poisoning

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