Academic Emergency Medicine

Cover image for Vol. 25 Issue 1

Edited By: Jeffrey A. Kline, MD

Online ISSN: 1553-2712

Associated Title(s): AEM Education and Training

Toxicology Virtual Issue


Welcome to the Toxicology Virtual Issue

Compiled by Mark B. Mycyk, MD

The toxicology “virtual issue” is a collection of key articles from Academic Emergency Medicine on the effects of toxins on the human body, recognizing and treating these effects, and developing the basic science of toxicology. The issue covers abused substances as well as other toxins perhaps less commonly seen by the emergency physician. This virtual issue will be updated on an ongoing basis as new articles are published.

Discoveries
Applications
Observations
Articles
Commentaries
Pediatrics
Education
Principles
Abuse
Antivenin
Safety


Toxicology Virtual Issue

DISCOVERIES

Kinetics and efficacy of an organophosphorus hydrolase in a rodent model of methyl-parathion poisoning.

Chemical agent simulant release from clothing following vapor exposure.

Determining the optimal dose of intravenous fat emulsion for the treatment of severe verapamil toxicity in a rodent model.

Effect of intravenous albumin infusion on brain salicylate concentration.

Hemodynamic effects of intralipid after verapamil intoxication may be due to a direct effect of fatty acids on myocardial calcium channels.

Endothelially derived nitric oxide affects the severity of early acetaminophen-induced hepatic injury in mice.

Hyperbaric oxygen reduces acetaminophen toxicity and increases HIF-1alpha expression.

Intralipid prolongs survival in a rat model of verapamil toxicity.

Multiple centrally acting antidotes protect against severe organophosphate toxicity.

Ziprasidone pretreatment attenuates the lethal effects of cocaine in a mouse model.

Physostigmine does not effect arousal but produces toxicity in an animal model of severe gamma-hydroxybutyrate intoxication.

Pharmacokinetic effects of diphenhydramine or oxycodone in simulated acetaminophen overdose.

Use of vasopressin in a canine model of severe verapamil poisoning: a preliminary descriptive study.

Effects of 4-methylpyrazole on ethanol neurobehavioral toxicity in CD-1 mice.

Jimson weed extract as a protective agent in severe organophosphate toxicity.

Diazepam inhibits organophosphate-induced central respiratory depression.

Hypertonic sodium bicarbonate for Taxus media-induced cardiac toxicity in swine.

Hyperbaric oxygen does not prevent neurologic sequelae after carbon monoxide poisoning.

Diphenhydramine as a protective agent in a rat model of acute, lethal organophosphate poisoning.

Direct correlation between diffusion of Loxosceles reclusa venom and extent of dermal inflammation.

Calcium and digoxin vs. calcium alone for severe verapamil toxicity.

The utility of an alcohol oxidase reaction test to expedite the detection of toxic alcohol exposures.

Intradermal anti-loxosceles Fab fragments attenuate dermonecrotic arachnidism.

Intraarterial vs intravenous administration of antivenin for the treatment of Crotalidae atrox envenomation: a pilot study.

Thermal characteristics of neutralization therapy and water dilution for strong acid ingestion: an in-vivo canine model.

Sodium polystyrene sulfonate treatment for lithium toxicity: effects on serum potassium concentrations.

Effect of delayed treatment with sodium polystyrene sulfonate on serum lithium concentrations in mice.

Recovery from severe cyclic antidepressant overdose with hypertonic saline/dextran in a swine model.

Verapamil Toxicity Dysregulates the Phosphatidylinositol 3-Kinase Pathway

Ziprasidone, Diazepam, or the Combination for Prevention of Cocaine Toxicity in a Mouse Model

Effects of Cocaine in an Experimental Model of Traumatic Brain Injury

Use of Vasopressin in a Canine Model of Severe Verapamil Poisoning: A Preliminary Descriptive Study

The Effects of Ecstasy (MDMA) on Rat Liver Bioenergetics

Preparing for Chemical Terrorism: Stability of Injectable Atropine Sulfate

Mitigation of Pennyroyal Oil Hepatotoxicity in the Mouse

Early Death Due to Severe Organophosphate Poisoning Is a Centrally Mediated Process

Oral Treatment of Organophosphate Poisoning in Mice

Attenuation of Verapamil-induced Myocardial Toxicity in an Ex-vivo Rat Model Using a Verapamil-specific Ovine Immunoglobin

Cocaine, Ethanol, and Cocaethylene Cardiotoxity in an Animal Model of Cocaine and Ethanol Abuse

N-Acetylcysteine Reduces Methemoglobin in an In-vitro Model of Glucose-6-phosphate Dehydrogenase Deficiency

Thermal Effects of Neutralization Therapy and Water Dilution for Acute Alkali Exposure in Canines

Histopathologic Evaluation of the Therapeutic Efficacy of Water and Milk Dilution for Esophageal Acid Injury

Cocaine and Ethanol: Combined Effects on Coronary Artery Blood Flow and Myocardial Function in Dogs

Hemodynamic Effects of Intravenous Fat Emulsion in an Animal Model of Severe Verapamil Toxicity Resuscitated with Atropine, Calcium, and Saline

lL-Carnitine Increases Survival in a Murine Model of Severe Verapamil Toxicity

Pretreating Rats with Parenteral Ophthalmic Antimuscarinic Agents Decreases Mortality from Lethal Organophosphate Poisoning

Comparison of Intravenous Lipid Emulsion, Bicarbonate, and Tailored Liposomes in Rabbit Clomipramine Toxicity

Intravenous Lipid Emulsion Does not Reverse Dabigatran-induced Anticoagulation in a Rat Model

Crotaline Fab Antivenom Reverses Platelet Dysfunction Induced by Crotalus Scutulatus Venom: An In Vitro Study



APPLICATIONS

Factors Associated With Difficulty Achieving Initial Control With Crotalidae Polyvalent Immune Fab Antivenom in Snakebite Patients

The In Vitro Effect of N-Acetylcysteine on Prothrombin Time in Plasma Samples From Healthy Subjects

Hepatotoxicity despite early administration of intravenous N-acetylcysteine for acute acetaminophen overdose.

Midazolam vs. diphenhydramine for the treatment of metoclopramide-induced akathisia: a randomized controlled trial.

Safety and efficacy of Crotalidae Polyvalent Immune Fab in pediatric crotaline envenomations.

Rattlesnake venom-induced thrombocytopenia response to Antivenin (Crotalidae) Polyvalent: a case series.

Comparison of the palatabilities of standard and superactivated charcoal in toxic ingestions: a randomized trial.

Effect of magnesium hydroxide on iron absorption following simulated mild iron overdose in human subjects.

Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose.

Brown recluse spider envenomation: a prospective trial of hyperbaric oxygen therapy.

Advantage of high-surface-area charcoal for gastrointestinal decontamination in a human acetaminophen ingestion model.

Incidence of Immediate Hypersensitivity Reaction and Serum Sickness Following Administration of Crotalidae Polyvalent Immune Fab Antivenom: A Meta-analysis



OBSERVATIONS

Relationship Between Cocaine Use and Coronary Artery Disease in Patients With Symptoms Consistent With an Acute Coronary Syndrome

Medication History Taking in Emergency Department Triage Is Inaccurate and Incomplete

The Association of Controlling Pseudoephedrine Availability on Methamphetamine-related Emergency Department Visits

Caffeinated cocktails: energy drink consumption, high-risk drinking, and alcohol-related consequences among college students.

Mechanical ventilation was associated with acidemia in a case series of salicylate-poisoned patients.

Predictors of mortality in patients with delirium tremens.

Acute ethanol coingestion confers a lower risk of hepatotoxicity after deliberate acetaminophen overdose.

Tracking inner city substance users from the emergency department: how many contacts does it take?

Identifying injection drug users at risk of nonfatal overdose.

Testing positive for methadone and either a tricyclic antidepressant or a benzodiazepine is associated with an accidental overdose death: analysis of medical examiner data.

Characteristics of Cocaine Users Presenting to an Emergency Department Chest Pain Observation Unit

Out-of-hospital care of critical drug overdoses involving cardiac arrest.

Profiles in patient safety: medication errors in the emergency department.

Ethanol and Illicit Drugs Do Not Affect the Diagnostic Utility of Base Deficit and Lactate in Differentiating Minor from Major Injury in Trauma Patients

Cocaine Use in Elder Patients Presenting to an Inner-city Emergency Department

Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport.

Digital imaging: a promising tool for mushroom identification.

Drug interactions in at-risk emergency department patients.

Etiology and weekly occurrence of alcohol-related seizures.

Routine carbon monoxide screening by emergency medical technicians.

Epidemiology and hospital course of rattlesnake envenomations cared for at a tertiary referral center in Central Arizona.

Early discharge of patients with presumed opioid overdose: development of a clinical prediction rule.

Clinical characteristics as predictors of recurrent alcohol-related seizures.

A comparison of two bedside tests for the detection of salicylates in urine.

Alcoholism in the Emergency Department: An Epidemiologic Study

Population-based incidence and outcome of acetaminophen poisoning by type of ingestion.

Cocaine-associated chest pain: how common is myocardial infarction?

Out-of-hospital and emergency department management of epidemic scombroid poisoning.

Emergency department observation of poisoned patients: how long is necessary?

Evaluation of two strategies for complying with state-mandated lead screening in the emergency department. Naussau-Suffolk Lead Committee, Naussau-Suffolk Lead Center.

Poison center data accuracy: a comparison of rural hospital chart data with the TESS database. Toxic Exposure Surveillance System.

Blood lead levels in emergency department patients with retained lead bullets and shrapnel.

The evaluation of cocaine-induced chest pain with acute myocardial perfusion imaging.

Carbon monoxide mass exposure in a pediatric population.

Acute renal failure associated with suspected Amanita smithiana mushroom ingestions: a case series.

Flunitrazepam and Its Involvement in Date or Acquaintance Rape

Cocaine-associated chest pain: one-year follow-up.

Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group.

Comparative efficacy of hemodialysis and hemoperfusion in severe theophylline intoxication.

A comparison of the bioavailabilities of oral and intravenous ethanol in healthy male volunteers.

Toxic ingestions in pregnancy: abortifacient use in a case series of pregnant overdose patients.

Herbal preparation use among urban emergency department patients.

A pharmacokinetic comparison of acetaminophen products (Tylenol Extended Relief vs regular Tylenol)

Out-of-hospital treatment of opioid overdoses in an urban setting.

Ethanol ingestion and related hypoglycemia in a pediatric and adolescent emergency department population.

Levamisole Exposure and Hematologic Indices in Cocaine Users

Bleeding Following Rattlesnake Envenomation in Patients With Preenvenomation use of Antiplatelet or Anticoagulant Medications

Incidence of Adverse Cardiovascular Events in Adults Following Drug Overdose

Randomized Clinical Trial of the Effect of Supplemental Opioids in Procedural Sedation With Propofol on Serum Catecholamines

Randomized Clinical Trial of Efficacy and Safety of a Single 2-mg Intravenous Dose of Hydromorphone Versus Usual Care in the Management of Acute Pain

Intranasal Fentanyl and High-concentration Inhaled Nitrous Oxide for Procedural Sedation: A Prospective Observational Pilot Study of Adverse Events and Depth of Sedation



ARTICLES

Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review.

Falsely elevated serum digoxin levels secondary to endogenous digoxin-like immunoreactive substances.

Critical Drug Shortages: Implications for Emergency Medicine



COMMENTARIES

Flumazenil: a pharmacologic antidote with limited medical toxicology utility, or … an antidote in search of an overdose.

Perfusion salad: making sense of verapamil overdose.

Medical toxicology training and certification.

Cocaine Chest Pain: Between a (Crack) Rock and a Hard Place …

Are Discharge Prescriptions of Opioids From the Emergency Department Truly Rising?

A Challenging Crossroad for Emergency Medicine: The Epidemics of Pain and Pain Medication Deaths

"Doctor, We Have No Saline Today": The Curious Case of the Generic Injectable Drug Shortage

Not Just Another Drunk

Early Serum Acetaminophen Levels: How Soon is too Soon?



PEDIATRICS

Safety and efficacy of Crotalidae Polyvalent Immune Fab in pediatric crotaline envenomations.

Evaluation of Race and Ethnicity on Alcohol and Drug Testing of Adolescents Admitted with Trauma

Selected tricyclic antidepressant ingestions involving children 6 years old or less.

Carbon monoxide mass exposure in a pediatric population.

Detection of Alcohol Use in Adolescent Patients in the Emergency Department

Ethanol ingestion and related hypoglycemia in a pediatric and adolescent emergency department population.

Serum ethanol clearance in intoxicated children and adolescents presenting to the ED.

Osmol Gaps in the Pediatric Population



EDUCATION

Substance use in emergency medicine training programs.

Online bioterrorism continuing medical education: development and preliminary testing.

Medical toxicology experience during emergency medicine residency

Emergency medicine faculty as poison center directors.

Medical toxicology training and certification.



PRINCIPLES

Falsely elevated serum digoxin levels secondary to endogenous digoxin-like immunoreactive substances.

Ethanol and Illicit Drugs Do Not Affect the Diagnostic Utility of Base Deficit and Lactate in Differentiating Minor from Major Injury in Trauma Patients

The utility of an alcohol oxidase reaction test to expedite the detection of toxic alcohol exposures.

A comparison of two bedside tests for the detection of salicylates in urine.

Osmol Gaps in the Pediatric Population

Levamisole Exposure and Hematologic Indices in Cocaine Users

The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness

Negative Predictive Value of Acetaminophen Concentrations Within Four Hours of Ingestion

Common Hand Sanitizer May Distort Readings of Breathalyzer Tests in the Absence of Acute Intoxication



ABUSE

Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose.

Cocaine and Ethanol: Combined Effects on Coronary Artery Blood Flow and Myocardial Function in Dogs. Lance D. Wilson LD, Malik M and Willson H.

The Association of Controlling Pseudoephedrine Availability on Methamphetamine-related Emergency Department Visits

Caffeinated cocktails: energy drink consumption, high-risk drinking, and alcohol-related consequences among college students.

Ziprasidone, Diazepam, or the Combination for Prevention of Cocaine Toxicity in a Mouse Model

The Effects of Ecstasy (MDMA) on Rat Liver Bioenergetics

Ziprasidone pretreatment attenuates the lethal effects of cocaine in a mouse model.

Predictors of mortality in patients with delirium tremens.

Physostigmine does not effect arousal but produces toxicity in an animal model of severe gamma-hydroxybutyrate intoxication.

Effects of Cocaine in an Experimental Model of Traumatic Brain Injury

Tracking inner city substance users from the emergency department: how many contacts does it take?

Identifying injection drug users at risk of nonfatal overdose.

Testing positive for methadone and either a tricyclic antidepressant or a benzodiazepine is associated with an accidental overdose death: analysis of medical examiner data.

Characteristics of Cocaine Users Presenting to an Emergency Department Chest Pain Observation Unit

Shedding new light on the "safe" club drug: methylenedioxymethamphetamine (ecstasy)-related fatalities.

Ethanol and Illicit Drugs Do Not Affect the Diagnostic Utility of Base Deficit and Lactate in Differentiating Minor from Major Injury in Trauma Patients

Cocaine Use in Elder Patients Presenting to an Inner-city Emergency Department

Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport.

Etiology and weekly occurrence of alcohol-related seizures.

Early discharge of patients with presumed opioid overdose: development of a clinical prediction rule.

Alcoholism in the Emergency Department: An Epidemiologic Study

Clinical characteristics as predictors of recurrent alcohol-related seizures.

Cocaine, Ethanol, and Cocaethylene Cardiotoxity in an Animal Model of Cocaine and Ethanol Abuse

The evaluation of cocaine-induced chest pain with acute myocardial perfusion imaging.

Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose.

Out-of-hospital treatment of opioid overdoses in an urban setting.

Ethanol ingestion and related hypoglycemia in a pediatric and adolescent emergency department population.

Cocaine-associated chest pain: one-year follow-up.

Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group

Traumatic Intracranial Injury in Intoxicated Patients With Minor Head Trauma

Sex Differences in Alcohol Misuse and Estimated Blood Alcohol Concentrations Among Emergency Department Patients: Implications for Brief Interventions

Clinical Pathologic Conference: A 51-year-old Man With Rash and Joint Pain



ANTIVENIN

Factors Associated With Difficulty Achieving Initial Control With Crotalidae Polyvalent Immune Fab Antivenom in Snakebite Patients

Intradermal anti-loxosceles Fab fragments attenuate dermonecrotic arachnidism.

Intraarterial vs intravenous administration of antivenin for the treatment of Crotalidae atrox envenomation: a pilot study.

Safety and efficacy of Crotalidae Polyvalent Immune Fab in pediatric crotaline envenomations.

Rattlesnake venom-induced thrombocytopenia response to Antivenin (Crotalidae) Polyvalent: a case series

Incidence of Immediate Hypersensitivity Reaction and Serum Sickness Following Administration of Crotalidae Polyvalent Immune Fab Antivenom: A Meta-analysis

Crotaline Fab Antivenom Reverses Platelet Dysfunction Induced by Crotalus Scutulatus Venom: An In Vitro Study



SAFETY

Medication History Taking in Emergency Department Triage Is Inaccurate and Incomplete

Profiles in patient safety: medication errors in the emergency department.

Drug interactions in at-risk emergency department patients.

Poison center data accuracy: a comparison of rural hospital chart data with the TESS database. Toxic Exposure Surveillance System.

Risk for Cost-related Medication Nonadherence Among Emergency Department Patients

Evidence-based Narratives to Improve Recall of Opioid Prescribing Guidelines: A Randomized Experiment

Rising Opioid Prescribing in Adult U.S. Emergency Department Visits: 2001-2010

Side Effects From Oral Opioids in Older Adults During the First Week of Treatment for Acute Musculoskeletal Pain

Effect of Barcode-assisted Medication Administration on Emergency Department Medication Errors

Effect of Electronically Delivered Prescriptions on Compliance and Pharmacy Wait Time Among Emergency Department Patients

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