ACMT/PCORI: Confronting the Overdose Epidemic by Engaging Patients to Improve Medical Toxicology Research

This month's articles will be reviewed by Northwell Health, led by Dr. Joshua Nogar.

Chemsex

ACMT members Gillian Beauchamp, MD, and Elizabeth (Elissa) Moore, DO deliver evidence-based medical toxicology core content and trending topics in easily digestible bites. Visit toxinten.com and follow on Twitter @toxinten.

Atypical Buprenorphine Initiation & Combinations: Using Opioid Affinity To Your Advantage

ACMT members Gillian Beauchamp, MD, and Elizabeth (Elissa) Moore, DO deliver evidence-based medical toxicology core content and trending topics in easily digestible bites. Visit toxinten.com and follow on Twitter @toxinten.

This month's articles will be reviewed by the Harvard Medical Toxicology Fellowship Program, led by Dr. Michele Burns.

"Beyond the Medications" - Non-Pharmacological Support for the Treatment of SUDs and Addiction

1. A 16-year-old girl presents to the ED after overdosing on medications she takes for rheumatoid arthritis. In the ED she has lightheadedness and runs of nonsustained ventricular tachycardia. 2. A 22-year-old man presents to the ED from prison after swallowing 50 bags of heroin and ten tablets of ecstasy. One hour after the ingestion, he is found unresponsive in his cell and requires naloxone. 3. A 66-year-old man presents to the ED with bilateral hand pain. He reports that earlier the same day he was cleaning coins at his home.

Fellows Experience with Micro and Macro Initiation

1. An 18-year-old man presents to the ED after a self-harm attempt in which he ingested a metal bar he purchased online. 2. A 13-year-old healthy girl is brought to the ED after a witnessed cardiac arrest. Although there is no history of ingestion, EMS brings bottles of amoxicillin and diosmin/hesperidin. Post ROSC, her vital signs are BP, 143/75 mmHg; HR, 120/min. On the ECG, her QRS is 86 msec and her QTc 450 msec. 3. A 50-year-old man with OUD presents to the ED after a suspected opioid overdose. He receives several low-dose boluses of IV naloxone over several hours. Due to recurrent and prolonged respiratory depression, his is started on a naloxone infusion.

Benzodiazepine dependence and withdrawal -treatment approaches and pharmacologic options.

Alcohol Impairment: Basic Medicolegal Issues

Suicide and Substance Use

1. A 70-year-old man with schizoaffective disorder and a recent viral illness presents to the ED from an assisted living facility with garbled speech, hypotension, and hypothermia. 2. An 80-year-old man with a history of alcoholic cirrhosis admitted for ascites has been on a flumazenil infusion for two weeks. He becomes sedated whenever the infusion is turned off. 3. A 49-year-old woman with a past medical history of schizophrenia presents to the ED with foot pain and altered mental status after recently being discharged from the hospital. Over the next 24 hours she becomes progressively more altered and nonverbal.

Xylazine Update

ACMT members Gillian Beauchamp, MD, and Elizabeth (Elissa) Moore, DO deliver evidence-based medical toxicology core content and trending topics in easily digestible bites. Visit toxinten.com and follow on Twitter @toxinten.

1. A 52-year-old man experiences cardiac arrest after an accident at a chemical plant. ROSC was obtained by EMS. He presents to the ED intubated and in a wide-complex tachycardia. 2. A 55-year-old man with a history of OUD, COPD, presents to ED in opioid withdrawal (COWS 17). Last use of opioid was 1 day earlier. He receives buprenorphine 32 mg over four hours. The patient becomes increasingly hypoxic throughout the night and is intubated for presumed pneumonia. 3. An 8-year-old boy presents after receiving “dipirona monoidratada” drops by his grandmother for fever. He is now complaining of abdominal pain.

Benzodiazepine Prescriptions and Their Ensuing Challenges

1. A 41-year-old woman presents with progressive leg swelling and a long-standing history of burning leg pain. 2. A 30-year old woman with nonverbal autism presents with 2 hours of recurrent syncope. 3. A 73-year-old man presents to the ED unresponsive following an intentional overdose of clonazepam. He is not protecting his airway, but he is DNR/DNI and family wants to respect his wishes.

Methadone Conundrums