UCONN Emergency Medicine Interest Group

Author Archive

Connecticut Toxicology: Plant Edition

In CONNECTICUT TOXICOLOGY on February 8, 2012 at 3:34 PM

Feed me Seymour, feed me!

The latest modules of Connecticut Toxicology have been released! Access them by clicking on the “Connecticut Toxicology” section header above, then scrolling down past the introduction/cover letter to the module that you want to take. These modules are all about plant life– from a general approach to their identification, to several individual poisonous or otherwise unpleasant plants. Did you ever wonder what would happen if you ate those berries that mom always told you to stay away from? Learn all about it by taking the modules! This is part of my selective project, and your help, by means of taking the surveys and reading through (or listening to) the modules would be much appreciated.

This is also the last group of modules to be released, meaning that the Connecticut Toxicology project is now completely published and available. Please feel free to explore!

Advertisements

Connecticut Toxicology: Mushroom, Mushroom!

In CONNECTICUT TOXICOLOGY on January 10, 2012 at 2:40 PM

The last modules of Connecticut Toxicology have been released! Access them by clicking on the “Connecticut Toxicology” section header above, then scrolling down past the introduction/cover letter to the module that you want to take. These modules are all about mushrooms- the basic process that a mycologist uses to identify them, and several species of poisonous¬† mushrooms that you really want to know. This is part of my selective project, and your help, by means of taking the surveys and reading through (or listening to) the modules would be much appreciated. The modules will eventually also be released in podcast form; however, due to computer issues, this will be somewhat delayed. Check them out!

Connecticut Toxicology: Marine Edition

In CONNECTICUT TOXICOLOGY on December 30, 2011 at 9:05 PM

The newest 2 modules of Connecticut Toxicology have been released! Access them by clicking on the “Connecticut Toxicology” section header above, then scrolling down past the introduction/cover letter to the module that you want to take. These 2 modules are marine in theme, with one module on jellyfish, and the other on stingrays. This is part of my selective project, and your help, by means of taking the surveys and reading through (or listening to) the modules would be much appreciated. The modules also come in podcast form, meaning that you can download them as MP3 files and listen to them on your iPod, or whatever other MP3 player or smartphone you might own on the go. Check it out!

Connecticut Toxicology: Snake, Snake, it’s a Snaaaaake!

In CONNECTICUT TOXICOLOGY on December 23, 2011 at 5:51 PM

HISSSSSSSSSSSS….. The next module of Connecticut Toxicology has been released! Access it by clicking on the “Connecticut Toxicology” section header above, then scrolling down past the introduction/cover letter to the module that you want to take. This latest module is about the two venomous snake species that live in Connecticut- do you know what they are? This is part of my selective project, and your help, by means of taking the surveys and reading through (or listening to) the modules would be much appreciated.

Book Review: Emergency Radiology – Case Studies

In REVIEWS on December 17, 2011 at 8:37 PM

This review is for the book Emergency Radiology: Case Studies, by David Schwartz, which can be purchased here. The reviewer has received no financial renumeration for this review.

I read this book prior to and during my radiology rotation to improve my knowledge about radiology specifically relevant to EM. There are several other books dedicated to this topic, but I felt this one struck the best balance between brevity and comprehensiveness. I felt that this case-based emergency radiology text was extremely helpful and well-written.

The text of the book is 559 pages. It is divided into 7 sections: chest X-ray, abdominal X-ray, upper and lower extremity X-ray, C-spine X-ray, head CT, and facial X-ray. Each section has a number of cases which serve to illustrate a particular point. The majority of the material presented was based on plain films, which I felt was appropriate, given that these are the most likely films that an emergency physician will have to interpret before the official radiologist reading; the exception to this is the section on head CT, which is, of course, a very important modality for EPs to be facile with. Notably, many of the cases describe initially missed findings by the radiologist, the emergency physician, or both, which resulted in a bounceback or other adverse outcome. The cases are also mostly not obvious- the book specifically addresses many more subtle findings that would and are often easily missed if they are not specifically looked for, such as hidden infiltrates on CXR, soft tissue swelling as a marker for fractures, and stroke mimics. Thus, the book definitely goes beyond the introductory level, and would very likely be a valuable read even to an experienced emergency medicine resident or attending.

Strengths of the book included the very clear writing style by a single author, excellent quality and quantity of images (there is nothing, in my opinion, more frustrating than trying to learn from terrible quality images), focus on radiology that is critical in EM, level of detail, and range of material presented. Weaknesses included omission of some topics that probably would be helpful (eg. hip dislocation), and general lack of ultrasound (although I understand that this is more of a conventional radiography book). In the end, I would definitely recommend this book.

Overall score (out of 5 stars):

Connecticut Toxicology: Creepy-Crawly Edition!

In CONNECTICUT TOXICOLOGY on December 9, 2011 at 9:12 AM

The first 2 modules of Connecticut Toxicology have been released! Access them by clicking on the “Connecticut Toxicology” section header above, then scrolling down past the introduction/cover letter to the module that you want to take. These 2 modules are creepy-crawly-themed, with one module on the poisonous spider that lives in Connecticut, and the other on those pesky stinging bees, wasps, and hornets (AKA Hymenoptera, for those who are more Latinate-inclined). This is part of my selective project, and your help, by means of taking the surveys and reading through (or listening to) the modules would be much appreciated. The modules also come in podcast form, meaning that you can download them as MP3 files and listen to them on your iPod, or whatever other MP3 player or smartphone you might own on the go. Check it out!

Web Spotlight 1: Life in the Fast Lane

In REVIEWS on November 27, 2011 at 3:57 PM

This is the first in a new series of posts highlighting some of the best online-based EM resources that can be found. Many of these are already present in the Links section, but this series is designed to give a little more information and guidance on what is out there, with a reduction in the risk of “information overload”. So, without further ado, here we go!

Life in the Fast Lane
Summary
Format: multiauthor blog.
Authors: a group of primarily Australasian emergency physicians and intensivists. Lead authors are Mike Cadogan and Chris Nickson.
Audio/visual media?: yes, although primarily just images.
Recurring features: links to current literature of interest, clinical cases (with special series on toxicology and EKG cases), rapid Q&A based explorations of topics of interest (e.g. noninvasive ventilation), and (sometimes questionable) humor.
Why you should check it out: virtually a one-stop shop for EM education needs. Very connected to other sites as well, so you will learn more about what it out there. The recurring series are excellent, especially the Q&A based cases and overviews of interesting topics, as they give you a chance to think about the answer before actually seeing it, and can be read through in just a couple of minutes. The EKG cases are great, and while are more advanced than what we are getting in medical school, are very accessible by the writing style. One very minor point to note is that given the authors are primarily from Australia and New Zealand, there may be some slight differences in drug names/drugs used (e.g. suxamethonium vs. succinylcholine), spellings, and scope of practice (for example, it appears that there are rural GPs in Australia that seem to be able to do virtually anything) but I have not to date found this to be a significant issue.

Book Review: Goldfrank’s Manual of Toxicologic Emergencies

In REVIEWS on November 13, 2011 at 7:00 AM

This review is for the book Goldfrank’s Manual of Toxicologic Emergencies, by R.S. Hoffman, L.S. Nelson, M.A. Howland, N.A. Lewin, N.E. Flomenbaum, and L.R. Goldfrank, which can be purchased here. The reviewer has received no financial renumeration for this review.

I purchased this book and read it through the toxicology rotation due to a personal interest in the subject matter. I wanted a text that would be comprehensive and detailed, but not so long that it would not be readable within approximately a month’s time (i.e., reading the big Goldfrank’s was not a viable option), and not so abbreviated that I would feel like it was too basic. Overall, I found this book to be an excellent choice.

The text of the book is 1066 pages (not including the index). It is divided into 3 main sections: General Approach to Medical Toxicology (discussing some basic principles of approaching the poisoned patient), Fundamental Principles of Medical Toxicology (primarily organized by organ systems and discussion of special populations), and Clinical Basis of Medical Toxicology (the heart of the book, discussing individual toxins and antidotes, as well as a final section discussing disasters, poison control centers, and epidemiology). The chapters discussing individual toxins or group of related toxins are generally organized in a consistent manner, with a discussion of pharmacology, pharmacokinetics, pathophysiology, clinical manifestations, diagnostic testing, and management. Where appropriate, the chapter on the antidote follows its respective toxin.

Strengths of the book including the overall homogeneity of the book, depth of discussion with practical information including dosages on management, mostly appropriate use of tables and charts, and comprehensive range of the material. Weaknesses include occasionally too brief discussion of certain toxins and lack of references. If you are looking for a fairly definitive reference in toxicology, that is a readable length, I would recommend this book.

Overall score (out of 5 stars):

Book Review: Introduction to Clinical Emergency Medicine

In REVIEWS on October 9, 2011 at 8:00 AM

This review is for the book An Introduction to Clinical Emergency Medicine edited by S.V. Mahadevan and Gus M. Garmel, which can be purchased here. The reviewer has received no financial renumeration for this review.

I purchased this book and read it in its entirety prior to beginning my first EM rotation, with the thought that it would be a good and comprehensive overview of emergency medicine that would be more digestible than reading through Tintinalli or some other “classic” textbook. In addition, I was somewhat sucked in by the novel organization of the book with chapters based on complaint, rather than problem, with the idea that each chapter would give me a method of approaching a patient with said complaint. While the book did seem to accomplish these goals to some degree, I found a number of flaws that made me walk away wishing I had put in the extra time to just read Tintinalli’s instead.

The text of the book is 752 pages (not including the index). It is divided into 4 main sections: Principles of Emergency Medicine (eg. airway management, shock, trauma, etc.), Primary Complaints, Unique Issues (eg. abuse, environmental emergencies, legal aspects), and Appendix (containing mostly information on common procedures done in the ED). More or less, each chapter is written by a different author (some authors contributed >1 chapter). This was a problem in the previous book review that I did due to lack of homogeneity between chapters, but in this book, there is a relatively rigid format with each chapter in Primary Complaints (which comprises the bulk of the text) describing the scope of the problem, relevant anatomy, approach to history (ie. what questions to ask and what they imply), physical exam, differential diagnosis, testing, treatment principles, special patients (eg. elderly, pediatric, and immunocompromised), disposition, and pearls/pitfalls. This format is followed by almost every chapter, and does make the book more consistent throughout. The material itself is quite basic, which you might take as a good thing or a bad thing, depending on what you are looking for. If you are truly looking for an introduction to emergency medicine, getting the basics is probably helpful. However, I found the lack of “new” information to me often frustrating, and I was frequently left wanting more. Another significant problem was the overuse of tables (a pet peeve of mine), and especially how general and lacking in detail the information therein provided was. This was a problem particularly in the differential diagnosis section, which relied heavily on the table format. Given that the actual book is mostly organized by complaint, rather than problem, there is very scant information about individual problems as a result of this; for example, identification and treatment of pulmonary embolism is treated only very superficially (which I’m not singling out- almost all disease in the book is described in the same manner).

Strengths of the book included the overall homogeneity of the book, excellent images, and the novel way in which emergency medicine is presented, as well as the relative brevity; individual chapters were generally less than 10 pages long. Weaknesses included the superficial treatment of individual diseases and overuse of tables and lists. I may have been somewhat biased in this review given that the book does present itself as an introductory text, rather than a comprehensive text, and thus if that is what you are looking for, this book may be a decent read. However, given that the book is 752 pages, and other introductory books targeted to medical students are significantly shorter (for instance, Blueprints is ~300 pages), while (if you restricted yourself to clinical topics only) other more definitive textbooks are not that far off in size, I feel this book occupies somewhat of a strained middle ground.

Overall score (out of 5 stars):

Pearl/Pitfall: Cyanide

In PEARL/PITFALL on October 2, 2011 at 8:00 AM

Based on discussion/lecture from Dr. O`Toole, Emergency Physician and Medical Toxicologist at Hartford Hospital:

In the case of a patient presenting with new onset seizures, tachycardia and hypotension with elevated lactate and acidosis, always consider cyanide poisoning as a potential etiology.

In brief, a lethal dose to adults of potassium cyanide is ~200 mg. Cyanide inhibits many enzymes, perhaps most importantly cytochrome oxidase at cytochrome a3 in the electron transport chain, inducing cellular asphyxia by preventing aerobic metabolism. This results in movement towards anaerobic metabolism, ultimately producing lactic acidosis.

Cyanide is also a neurotoxin by several mechanisms, including impairment of metabolism as above, as well as increased release of excitatory neurotransmiters and increasing/activation of NMDA receptor activity, producing a number of CNS s/s including seizures.

It should be noted that cyanide does cause variable cardiovascular effects depending on when in the course of the exposure the patient is observed. Initially, cyanide causes bradycardia and hypertension, followed by hypotension and reflex tachycardia, and finally, bradycardia and hypotension leading to death.

As there is now a very safe antidote, hydroxocobalamin available, which essentially binds cyanide to become cyanocobalamin (ie. vitamin B12), early recognition of this poisoning may be life-saving.

Reference:

Hoffman, Robert. Goldfrank’s Manual of Toxicologic Emergencies. New York: McGraw-Hill, 2007.

%d bloggers like this: