mr. freeze Chief Complaint: Painful wounds on skin for months HPI: 32-year-old male with past medical history of alcohol use disorder and general anxiety disorder presents with painful skin wounds to the right thigh for approximately four months. He curbed his cravings for EtOH with inhalant use. He uses keyboard duster cans several times a…
Read MoreContributor: Gretchen Hinson, MD Educational Pearls: Pit vipers include cottonmouths, rattlesnakes, and copperheads All have folding long fangs, triangular face, and elliptical pupils About 5,000 snakebites per year reported to Poison Control Initially develop a local reaction (swelling, bruising, pain, bullae) Complications can include 25% of snake bites result in no envenomation (dry bites) 20%…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Acid and alkali ingestions have differing prognosis and immediate concerns Immediate issues can include superficial irritation, severe burns, esophageal perforation, and even airway compromise from edema Long term morbidity can include strictures Supportive care is typically all that can be provided in the emergency department Diagnostics may include imaging…
Read MoreContributor: Katie Sprinkel, MD Educational Pearls: Commonly known as “acid,” LSD is seeing a resurgence in the population as a recreational hallucination Onset is about 30 minutes with peak pharmacologic effects at 2-4 hours, the drug’s half life is 3 hours resulting in some prolonged effects While there is not an significant addictive component of…
Read MoreContributor: Ruben Marrero-Vasquez, PharmD Educational Pearls: ACEP and FDA have both issued warnings about the viral Tik Tok Benadryl (diphenhydramine) challenge where individuals voluntarily overdose on diphenhydramine which can cause fatal toxicity Diphenhydramine is typically dosed at 0.5-1 mg/kg in pediatric patients Q4-6 PRN and carries a fatal dose of 20-40 mg/kg but anywhere from…
Read MoreContributor: Don Stader, MD Educational Pearls: Majority of patients experience side effects while taking opioids Most common include nausea/vomiting, puriitis, constipation; more severe and less common include respiratory depression, addiction and overdose Opiates can cause nausea, but ondansetron (Zofran) is the wrong treatment because it’s not antidopaminergic. Instead consider using metoclopramide (Reglan), olanzapine (Zyprexa), or…
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Silent, Scentless and Deadly Chief Complaint: Headache HPI: A family consisting of a 22-year-old female, 27- year-old male and 10 month-old male presenting to the emergency department by EMS with family with concern for headache. Female is reporting around 1612 she came home from work and was doing her hair when she began experiencing a…
Read MoreContributor: Nick Hatch, MD Educational Pearls: Kratom is derived from the evergreen tree sharing the same name, found in Southeast Asia Kratom is legal is most regions Adverse effects of this substance are increasing in prevalence as its use becomes more widespread At lower doses kratom has a stimulatory effect Higher doses of kratom can…
Read MoreContributor: Erik Verzemnieks, MD Educational Pearls: Baclofen is used to treat muscle spasms or spasticity. Baclofen comes in two forms: oral and intrathecal Withdrawal is much more common with those receiving intrathecal administration from a Baclofen pump, which is typically spinal cord patients Withdrawal symptoms usually start within 1-3 days after stopping baclofen Symptoms include…
Read MoreContributor: Donald Stader, MD Educational Pearls: Not uncommon for patients presenting after opiate overdose and narcan administration to be observed for 4-6 hours This has been based more on tradition than evidence Observation periods for overdose may vary based on the opiate(s) used Fentanyl and heroin have half lives of about 2 hours, while oxycodone…
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