Poisoning , contaminated water, can be in some preservatives
Acute ingestion-garlic smell of breath and tissues, GI symptoms, dehydration, pulmonary edema, shock
Arsine gas exposure- homelysis, hematuria, jaundice
Workup: Urine arsenic level, EKG, cbc with retic, CMP, mg, phos, ca, lfts, CK
Management: Supportive care, ABCs, IV, O2, remove exposure, IVF, Avoid QTC prolonging meds
CHELATION therapy if severe symptoms, Dimercaprol. (Tough to Find) DMPS may be better alternative but logistically tough. Call Poison Control Center ASAP to help manage. Charcoal absorbs poorly to arsenic, evaluate for exchange transfusion in arsine exposure
Admit to ICU if symptomatic from acute exposure, Asymptomatic can be obs
Toxicology Oral Boards Prep (Eisenstat)
Oral Boards Update: ABEM made significant changes to licensing exams starting in 2026. Stay tuned for updates and details on how this develops.
Botulism
Infant, Wound, Food Bourne
Supportive Care: Early Vent support, Wound management
Foodborne/Inhalational: Equine Serum Botulism Antitoxin- through CDC, Department of Health
Infant: Botulism IG (BabyBIG) through CDC, Department of Health
Wound- ID, broad spectrum, tx similar to nec fasc
Carbon Monoxide Poisoning
Critical Actions:
Perform Complete Neurologic Exam
POC Glucose
ABG with carboxyhemoglobin
100% NRB
Admit for O2 therapy or transfer for hyperbarics
Environmental Tox (McGowen)
Sorry, was too busy playing Kahoot. Study up for ITE.
Management: Reverse Triage Mass Casualty- Cardiac Arrest->ACLS immediately. Have higher survival rate, ROSC before breathing, apneic patients need assisted breathing. Cease efforts if no ROSC after 20-30 minutes.
Discharge- normal vitals, appears well, no other injuries
Admit essentially everyone else, likely will require tele monitoring
Obtain CT imaging to rule out internal hemorrhage, as lighting can affect similar to blunt trauma
What To Do: Get in a Car, go inside a deep cave, Go deep into a forest. Isolated Trees are bad. Go to Ravine if in the mountains.
Toxic Mushrooms (Webb)
mushrooms are closer to humans than plants genetically (trust me bro)
7500 ingestions annually, 3 deaths per year
Typically Acute gastroenteritis, usually less than 3 hours post ingestion
Classic: Primary Met Acidosis with Primary Resp Alkalosis. Determine if decrease in CO2 is compensation or if there is another primary acid base disturbance
Tachypnea is not an indication for intubation. AVOID INTUBATION IF POSSIBLE
Give 1-2 mEq/kg bolus of bicarb peri-intubation, awake intubation, Vent settings to match minute ventilation pre-intubation to prevent resp acidosis. High rate and volumes needed (Rate 30, 8 cc/kg example).
External and Internal Decon- remove any topical source like Bengay cream. Role of Charcoal depending on mental status.
Treatments: Sodium Bicarb
Dosing: Bolus 1-2mEq/kg. Maintenance: 3 amps in 1 L D5W, 150-200 ml/hr maintenance rate
Goal serum pH 7.5-7.55, Goal Urine pH 7.5-8.0
Treatment endpoints: ASA level below 30 x2.
Chronic Intoxications typically overlooked. Oil of Wintergreen is highly concentrated and potentially fatal.