UCONN Emergency Medicine Interest Group

Posts Tagged ‘toxicology’

Connecticut Toxicology – last call

In ANNOUNCEMENTS, CONNECTICUT TOXICOLOGY on March 25, 2012 at 3:13 PM

The Connecticut Toxicology project will be concluding data collection by April 1st, 2012. If you have not already, please feel free to take a look at one or more of the modules, accessible by going to the “Connecticut Toxicology” tab above and scrolling down through the choices. Please make sure to complete both the pre and post-module surveys.

Thank you,
Max Falkoff, MS4

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!

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 poisonousĀ  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.

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!

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):

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.

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