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Everything's Red This Month: Rashes, Secretions, and Laboratory Values

Pediatric Emergencies from Cannabinoid Exposure

Unexplained Hypoxia, Seizures, and Ingestion

Missed Diagnoses and Misleading Drugs

Protecting Pediatric Patients from Poisoning: Production, Packaging & Purpose

Clinical Cannabis Considerations in Children, Harvard Medical Toxicology Fellowship Program

Toxic Disasters in the Newborn! An Approach to the Problem

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.

1. A 22-year-old, 32-week pregnant woman presents to the ED after an intentional ingestion of an insecticide called "Sniper." Her initial vital signs are: BP, 126/78 mmHg; HR, 96/min; RR, 26/min; T, 98.9F; O2 Sat, 98% (RA). She has increased salivation per the treating physician. 2. A 16-year-old girl presents with a presumed pseudoephedrine overdose. Her vital signs are HR 137, BP 198/158, RR 30, T 36.7. After an observation period of 5 days she has not improved. 3. A 39-year-old man is transferred from a treatment center to the ED for opioid withdrawal and intractable vomiting Several hours after arrival at the treatment center that morning, he developed worsening opioid withdrawal for which he received methadone (30mg) but immediately vomited and became "shaky." His initial vital signs are: BP, 153/95 mmHg; P, 83/min; RR, 22/min; T, 99 F; Sp02, 96%

1. A 7-day-old boy in the NICU is receiving TPN and dopamine through a left forearm peripheral IV that is noted to have extravasated. This is suspected to have begun two 2 hours earlier. 2. A 30-year-old man is cleaning his saltwater tank when "something" gets in his eye. Four hours later he develops a fever, cough, and shortness of breath. 3. A 38-year-old woman on INH monotherapy for latent TB presents with RUQ abdominal pain. She is noted to have: AST 545, ALT 130, AlkPhos 156, nl bilirubin. A RUQ sonogram is negative.

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.