2024 ACMT Total Tox Course | Live Event Package
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Register
- Non-member - Tier I - $575
- Non-member - Tier II - $575
- Non-member - Tier III - $350
- Non-member - Tier IV - $200
- Member - Tier I - $500
- Member - Tier II - $500
- Member - Tier III - $275
- Member - Tier IV - $125
#TotalTox2024
Join us for the ultimate virtual toxicology learning experience with the 2024 ACMT Total Tox Course | Live Event Package!
During this live, virtual event, earn valuable continuing education credits, learn from leading experts and peers, and enhance your clinical skills and preparedness for a wide range of toxicological emergencies. Included with your registration fee are up to 24.0 (8.0 per day) of continuing education credits for Physicians, Physician Assistants, Pharmacists, Nurses, and Nurse Practitioners. Learn from leading experts and peers, and enhance your clinical skills and preparedness for a wide range of toxicological emergencies. Secure your spot in the ACMT Total Tox Course today!
This course will focus on the follow medical toxicology topics:
Pharmaceuticals - Friday, 11/01/2024
Our first session will examine systematic approaches to managing poisoned patients, covering mechanisms of toxicity and treatment guidelines for substances like acetaminophen, NSAIDs, and SSRIs. Interactive case panels will allow you to apply theoretical knowledge to real-world scenarios, enhancing your clinical decision-making skills.
SUD & Emergency Preparedness - Friday, 11/08/2024
The first half of this session will cover substance use topics like opioid addiction, cannabis toxicity, and new substances. Experts will also discuss drug screen issues, pulmonary irritants, and the effects of mitochondrial asphyxiants on first responders to chemical suicides. We will conclude with a focus on disaster preparedness, including radiation types and symptom management, nerve agents, and a brief history of bioterrorism and identification of agents. Interactive case panels with expert speakers will focus on substance use disorder and disaster preparedness.
Non-Pharmaceuticals - Friday, 11/15/2024
The final session of the Total Tox Course will focus on the toxicology of plants and mushrooms, and reptile, marine, and arthropod envenomations. Experts will also cover anesthetic toxicity, malignant hyperthermia, and methemoglobinemia. Gain expertise in managing heavy metal poisoning and the complexities of ethanol and toxic alcohol intoxication. Participate in interactive case panels on novel treatments for critically ill patients and evaluation of an unknown potential toxicology issue, bringing together all your knowledge from the Total Tox Course.
Questions?
Please write to ACMT at events@acmt.net
Preliminary Agenda
Session 1 - November 1, 2024
8:50 - 9:00 AM ET | Opening Remarks
9:00 - 9:45 AM ET
From Toxidromes to Activated Charcoal: A Rational Approach For Managing the Poisoned Patient
Ann Arens, MD Associate Professor of Emergency Medicine, University of Minnesota, Minneapolis, MN
Dr. Arens will identify the most common interventions performed in acute poisoning, and will examine a poisoned patient to identify what to look for in common poisonings. She will also discuss different treatment options for common toxidromes.
9:45 - 10:15 AM ET
Over-the-Counter Poisons #1: Acetaminophen
Neeraj Chhabra, MD, MSCR Medical Toxicologist & Emergency Medicine Physician, University of Illinois Chicago, Chicago, IL
Dr. Chhabra will discuss acetaminophen ingestions. He will explain how to recognize which patients require treatment and identify novel treatments for acetaminophen-related poisoning.
10:15 - 11:00 AM ET
Over-the-Counter Poisons #2: NSAIDS and ASA
Renee Petzel Gimbar, PharmD Clinical Associate Professor, University of Illinois Chicago College of Pharmacy, Chicago, IL
Dr. Petzel Gimbar will describe the treatment of NSAID poisoning, discuss the pathophysiology of salicylate poisoning, and examine the difference between treatment for NSAID and salicylate poisoning.
11:00 - 11:15 AM ET | Break - 15 min
11:15 - 11:30 AM ET
Case Review
Several speakers from previous lectures will return to review and discuss clinical cases.
11:30 - 12:00 PM ET
Over-the-Counter Poisons #3: Antihistamines & Antitussives
Michelle Hieger, DO Emergency Physician and Medical Toxicologist, WellSpan Health & VCU Health System, York, PA
Dr. Hieger will describe the action of antitussive medications and the pharmacology of antihistaminics with emphasis on clinical uses, adverse drug reactions and interactions. She will also identify major antihistamines used to treat breathing problems.
12:00 - 12:45 PM ET
The Ins and Outs of Ups and Downs #1: Tricyclic Antidepressants & Antipsychotics
J.J. Rasimas, MD, PhD, FAACT, FACLP, FACMT, FACPsych Professor of Psychiatry & Emergency Medicine, University of Minnesota & Penn State College of Medicine, Minneapolis, MN
Dr. Rasimas will explain the pharmacologic, toxicity, and treatment differences between Tricyclic Antidepressants and Antipsychotics. He will discuss "typical" vs. "atypical" antipsychotics and describe the overlapping features of Serotonin Syndrome, Anticholinergic Syndrome, and NMS produced by TCAs and Antipsychotics.
12:45 - 1:15 PM ET
The Ins and Outs of Ups and Downs #2: SSRIs and Lithium
Katherine Katzung, MD, FACEP, FASAM Director of Addiction & Toxicology Program & Emergency Care Physician, Abbott Northwestern Hospital & Emergency Care Consultants, Minneapolis, MN
Dr. Katzung will identify unique concerns of specific antidepressants in overdose and compare differences in acute vs. chronic lithium toxicity. She will also discuss drug discontinuation syndrome as it applies to SSRIs & atypical antidepressants.
1:15 - 1:45 PM ET | Break - 30 min
1:45 - 2:15 PM ET
Beta Blockers and Calcium Channel Blockers: When the Antagonists Become Antagonistic
Katherine Katzung, MD, FACEP, FASAM Director of Addiction & Toxicology Program & Emergency Care Physician, Abbott Northwestern Hospital & Emergency Care Consultants, Minneapolis, MN
Dr. Katzung will return after the break to examine treatment options focusing on high-dose insulin vs vasopressor controversy and discuss mechanisms of toxicity, clinical manifestations, and updates on optimal therapy for beta-adrenergic blocking drugs and calcium channel antagonists drugs.
2:15 - 2:30 PM ET
Case Review
Several speakers from previous lectures return to review clinical cases.
2:30 - 3:00 PM ET
Drug-Induced Dysrhythmias: When You Can't Control the Rhythm
William "Russ" Kerns, II, MD, FACMT, FACEP Emeritus Professor of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
Dr. Kerns will examine optimal treatment of drug-induced dysrhythmias and discuss how the optimal management of drug-induced dysrhythmias differs from AHA ACLS algorithms.
3:00 - 3:45 PM ET
Anticoagulants and Antithrombotics: When You Can't Control the Bleeding
Nena Bowman, PharmD, DABAT Director of Vaccine Operations, Vaccine Preventable Diseases and Immunization Program, Tennessee Department of Health, Nashville, TN
Dr. Bowman will identify appropriate uses of reversal agents for common anticoagulants and summarize the latest data in NOAC trials. She also will review the mechanism of action, indications, contraindications, adverse reactions, and common drug interactions of warfarin.
4:45 - 4:00 PM ET | Break - 15 min
4:00 - 4:30 PM ET
Out of Balance: Toxicity of Endocrine Agents
Charles McKay, MD, FACMT Associate Medical Director, CT Poison Control Center, University of Connecticut School of Medicine, Farmington, CT
Dr. McKay will examine management issues with overdose of endocrine drugs, and discuss endocrine clues and mimics and endocrine function impact of ‘non-endocrine’ medications.
4:30 - 5:00 PM ET
Anticonvulsants: When the Level Makes You Unsteady
Daniel J. Sessions, MD Medical Toxicologist, Ochsner Medical Center, New Orleans, LA
Dr. Sessions will identify treatment options for anticonvulsant toxicity, examine laboratory testing is required for toxicity from anticonvulsant agents, and discuss the toxicity of common anticonvulsants.
5:00 - 5:30 PM ET
Antimicrobials & Antivirals: When the Cure Becomes Toxic
Maryann Amirshahi, PharmD, MD, MPH, PhD, FACMT Emergency Medicine Attending Physician and Associate Professor Of Emergency Medicine, MedStar Washington Hospital Center & Georgetown University Hospital, Washington, D.C.
Dr. Amirshahi will discuss the mechanism of action of the five major classes of antimicrobials. She will describe the potential toxicities of commonly prescribed antimicrobial treatments and assess the likelihood of a cross-reaction between penicillin and cephalosporin.
Session 2 - November 8, 2024
8:50 - 9:00 AM ET | Opening Remarks
9:00 - 9:45 AM ET
The New Dangers of Opioid Addiction
Lewis Nelson, MD, FACEP Chair of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
Dr. Nelson will describe opioid use disorder and explain how to initiate treatment for opioid use disorders. He will also highlight harm reduction efforts that can reduce the adverse consequences of opioid use.
9:45 - 10:15 AM ET
Management Options for Opioid Use Disorder
Rachel Wightman, MD, FACMT Assistant Professor of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
Dr. Wightman will review the misuse, abuse, & criteria for diagnosing opioid use disorder. She will identify psychosocial treatments for opioid use disorder and describe the medication-assisted treatments for Buprenorphine, Methadone, and Naltrexone.
10:15 - 10:45 AM ET
Cannabis & Cannabis Toxicity
Mark Neavyn, MD, FACMT Medical Director & Emergency Medicine Physician, Northern New England Poison Center & Maine Medical Center, Portland, ME
Dr. Neavyn will examine the symptoms of cannabis toxicity and describe the treatment approach to cannabis toxicity.
10:45 - 11:00 AM ET | Break (15 min)
11:00 - 11:15 AM ET
What's New in Your Neighborhood?
Stephanie Weiss, MD, PhD Staff Clinician, Translational Addiction Medicine Branch, National Institute on Drug Abuse, Baltimore, MD
Dr. Weiss will discuss the epidemiology of new fentalogues and explain how to initiate treatment for fentanyl-related overdose.
11:15 - 12:00 PM ET
Case Review
Several speakers from previous lectures return to review clinical cases
12:00 - 12:30 PM ET
Drug Screen Pitfalls
Paul M. Wax, MD, FACMT Executive Director, American College of Medical Toxicology (ACMT), Phoenix, AZ
Dr. Wax will Identify toxicology tests available in the ED. He will discuss which tests should be requested in specific situations and describe how test ordering changes treatment outcomes.
12:30 - 1:00 PM ET | Break (30 min)
1:00 - 1:45 PM ET
Inhaled Toxicants: Simple Asphyxiants & Respiratory Irritants
Charles McKay, MD, FACMT Associate Medical Director, CT Poison Control Center, University of Connecticut School of Medicine, Farmington, CT
Dr. McKay will discuss the role of water solubility in the clinical presentation of pulmonary irritants and describe the clinical presentation of pulmonary irritants.
1:45 - 2:15 PM ET
Chemical Suicide & Mitochondrial Asphyxiants
Paul M. Wax, MD, FACMT Executive Director, American College of Medical Toxicology (ACMT), Phoenix, AZ
Dr. Wax will return to examine the sources and uses of chemical asphyxiants, their basic mechanisms of toxicity, and their clinical presentations. He will identify the differences between simple asphyxiants and chemical asphyxiants and compare therapies used to treat asphyxiant poisoning.
2:15 - 2:45 PM ET
Carbon Monoxide Poisoning: High Flow Oxygen or the Hyperbaric Chamber
Kelly Johnson-Arbor, MD, FACEP, FUHM, FACMT Medical Director, National Capital Poison Center & MedStar Georgetown University Hospital, Washington, DC
Dr. Johnson-Arbor will identify different types of radiation, describe the consequences of exposure to radiation, and discuss the diagnosis and management of radiation casualties and radiation mass casualty events.
2:45 - 3:15 PM ET
Disaster Preparedness #1: Radiation Events
Joseph K. Maddry, Lt Col, USAF, MC, FS, MD, FACMT Deputy Commander, Department of Emergency Medicine, US Army Institute of Surgical Research, Houston, TX
Dr. Maddry will discuss the diagnosis and management of radiation casualties and radiation mass casualty events. He will also identify different types of radiation and describe the consequences of exposure to radiation.
3:15 - 3:30 PM ET | Break (15 min)
3:30 - 4:00 PM ET
Disaster Preparedness #2: Organophosphates & New Agents
Christina Hantsch, MD, FACEP, FACMT, FAACT Emergency Physician and Medical Toxicologist, Loyola University Chicago Stritch School of Medicine Maywood, IL
Dr. Hantsch will discuss management options for patients with organophosphate insecticide or nerve agent toxicity and explain cholinergic toxidrome. She will list specific organophosphate insecticides and chemical weapon nerve agents.
4:00 - 4:45 PM ET
Disaster Preparedness #3: Other Chemical & Biological Terrorism
Aaron Frey, DO Emergency Medicine Attending Physician and Medical Toxicology Fellow, Richmond Emergency Physicians, Inc. & University of Virginia, Richmond, VA
Dr. Frey will examine the diagnosis and management of casualties resulting from terrorism and mass casualty events and discuss the history of bioterrorism as a tool for warfare. He will explain and evaluate the agents used in bioterrorist events.
4:45 - 5:30 PM ET
Case Review
Several speakers from previous lectures return to review clinical cases.
Session 3 - November 15, 2024
8:50 - 9:00 AM ET | Opening Remarks
9:00 - 9:30 AM ET
Hospital Hazards #1: Anesthetic Toxicity & Malignant Hyperthermia
Shaun D. Carstairs, MD, FACMT Medical Toxicologist, 98point6, Inc., Seattle, WA
Dr. Carstairs will discuss the history and pharmacology of local anesthetics and the unique characteristics and common clinical use for each prototypical local anesthetic. He will assess the most commonly caused several complications of local anesthetics and identifies general thermoregulatory principles. He will also review the following hyperthermic syndromes & discusses treatment options: Serotonin Syndrome, Neuroleptic Malignant Syndrome, and Malignant Hyperthermia.
9:30 - 10:00 AM ET
Hospital Hazards #2: Methemoglobinemia
Andrea Carlson, MD Emergency Medicine Physician, Advocate Christ Medical Center, Oak Lawn, IL
Dr. Carlson will discuss the common agents causing Methemoglobinemia. She will identify methemoglobinemia mechanisms of toxicity and describe the best practices in clinical management of methemoglobinemia.
10:00 - 10:30 AM ET
Heavy Metals In the ED: Lead, Arsenic & Mercury
Evan Schwarz, MD, FACMT, FASAM, FACEP Medical Toxicology Fellowship Director, University of California, Los Angeles, Los Angeles, CA
Dr. Schwarz will review the signs and symptoms of lead toxicity. He will discuss the role of chelation in heavy metal toxicity and compare and contrast the toxicity caused by different forms of mercury.
10:30 - 10:45 AM ET | Break (15 min)
10:45 - 11:45 AM ET
Case Panel: Novel Treatments for the Crashing Patient
Several speakers from previous lectures will return to review clinical cases.
11:45 - 12:30 PM ET
Ethanol Intoxication: Too Much Of a Good Thing
Anthony Pizon, MD, FACMT Chief of Medical Toxicology Division, Professor of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
Dr. Pizon will examine the prevalence of ethanol AUD in patients presenting to the Emergency Department. He will also discuss the genetic vs. environmental factors for ethanol AUD and assess the most critical laboratory tests for symptomatic patients who have suspected ethanol intoxication.
12:30 - 1:15 PM ET
When It's Not Ethanol: Demystifying Toxic Alcohols
Bram Dolcourt, MD Clinical Assistant Professor Department of Emergency Medicine, Wayne State University, Detroit, MI
Dr. Dolcourt will describe toxicity & time course of methanol (MeOH) and ethylene glycol (EthGly) exposures, identify two stand-in tests for MeOH and EthGly, noting limitations, and present a rationale for treatment with ethanol, fomepizole, and/or hemodialysis.
1:15 - 1:45 PM ET | Break (30 min)
1:45 - 2:15 PM ET
Ethanol Withdrawal: When the Good Times End
Jerrold Blair Leikin, MD, FACP, FACEP, FACMT, FAACT, FACOEM, FASAM Adjunct Clinical Professor Division of Environmental and Occupational Health Sciences & Professor of Medicine, University of Illinois Chicago and Rosalind Franklin University of Medicine & Science, North Chicago, IL
Dr. Leikin will discuss appropriate treatment so that complications are prevented. He will examine alcohol withdrawal symptoms and describe the principles of detoxification.
2:15 - 2:45 PM ET
Don't Touch That! Marine, Arthropod & Reptile Envenomations
Michael Levine, MD, FACMT Associate Professor of Emergency Medicine, University of California Los Angeles, Los Angeles, CA
Dr. Levine will identify various toxic envenomations and describe the characterization of Black Widow envenomation and management options. He will also discuss management options for pit viper envenomations.
2:45 - 3:15 PM ET
The Toxic Yard
Fiona Garlich Horner, MD Head of Toxicology & Assistant Professor of Clinical Emergency Medicine, LAC+USC Medical Center & University of Southern California Keck School of Medicine, Los Angeles, CA
Dr. Garlich Horner will examine different classes of plant derived toxins and their effects on humans and identify hazards of different mushrooms and clinical toxidromes associated with mushrooms.
3:15 - 3:45 PM ET
The Toxic House
Ashley Haynes, MD, FACEP Medical Director, Addiction Toxicology of Kansas, Wichita, KS
Dr. Haynes will discuss common household exposures and their implications and review the toxicity of common household cleaners and toys.
3:45 - 4:00 PM ET | Break (20 min)
4:00 - 4:30 PM ET
The Toxic Cabinet
Stephen Wood, MS, ACNP-BC, FEWM Acute Care Nurse Practitioner & Director of Advanced Practice Providers, St. Elizabeth’s Medical Center, Brighton, MA
Nurse Practitioner Wood will review toxicity of essential oils and examine the risks associated with the use of dietary supplements.
4:30 - 5:00 PM ET
The Toxic Garage
Andrew King, MD Associate Professor in the Department of Emergency Medicine & Medical Director, Wayne State University School of Medicine & Michigan Poison and Drug Information Center, Detroit, MI
Dr. King will discuss common toxins and exposures of chemicals commonly found in the garage. He will also review toxicity and management of chemicals and other substances commonly found in the garage.
5:00 - 5:30 PM ET
Case Panel
Several speakers from previous lectures will return to review clinical cases.
Registration Rates
Registration includes:
- Access to all three sessions of the live virtual event on November 1, 8, 15, 2024
- Access to the on-demand recording for 90 days after the event
- Access to the Speaker slides
- 24.0 Continuing Education Certificate. Available credits: Continuing Medical Education (CME), Continuing Nursing Education (CNE), Continuing Pharmacy Education (CPE), Continuing Medical Education for Physician Associate (AAPA CME), and Continuing Education for Nurse Practitioners (AANP CE).
Are you a member of any of the following organizations: AAEM, AAENP, APC, APAMT, EAPCCT, SOT, MENATOX? You may be eligible for a registration discount! Please email us at events@acmt.net for more information.
Member Rates
Member Tier I: Full, Affiliate, International, Emeritus |
$500 |
Member Tier II: Fellows |
$500 |
Member Tier III: Residents, International - Developing Country |
$275 |
Member IV: Medical Students |
$125 |
Non-Member Rates
Non-member Tier I: Physicians, Pharmacists, Lawyers, "Other" |
$575 |
Non-member Tier II: Fellows, SPIs, Nurses, etc. |
$575 |
Non-member Tier III: Educators & Emergency Responders |
$350 |
Non-member IV: Residents & Students |
$200 |
ACMT Membership
ACMT Members receive a discounted rate. Interested in becoming an ACMT Member? Contact our Membership Team at membership@acmt.net. Learn more at: www.acmt.net/membership
Group Discounts Available
Is your hospital or medical group interested in enrolling multiple employees in our course? We offer special discounts for organizations with multiple participants. Contact us at events@acmt.net for more details!
Refunds and Cancellations
- Cancellations made 15 days or more in advance of the event date will receive a full refund less a 8% processing fee.
- Cancellations made within 14 days of the event date will not receive a refund.
All cancellation requests must be made in writing and emailed to: events@acmt.net. No telephone cancellations will be accepted. A refund that results from a cancellation or change to your registration will be returned to the original payer and in the original method of payment.
Pending review, limited exceptions will be made based on need and circumstance (family emergency, for example) and must be submitted in writing to events@acmt.net. For these instances, the full registration fee, minus a 8% processing fee, will be refunded. Because each exception must undergo a review and approval process, we ask in advance for your patience.
Questions?
For any questions, please email us at events@acmt.net.
Continuing Education
CE credit provided by AKH Inc., Advancing Knowledge in Healthcare.
In support of improving patient care, this activity has been planned and implemented by AKH Inc., Advancing Knowledge in Healthcare and American College of Medical Toxicology (ACMT). AKH Inc., Advancing Knowledge in Healthcare is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
This activity was planned by and for the healthcare team, and learners will receive 8.0 Interprofessional Continuing Education (IPCE) credit for learning and change.
Physicians
AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 8.0 AMA PRA Category 1 Credit(s)™ per session. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurses
Credit being awarded: 8.0 ANCC contact hours per session.
Nurse Practitioners
This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and American College of Medical Toxicology (ACMT). AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 030803. This activity is approved for 8.0 contact hour(s) per session (which includes 8.0 hour(s) of pharmacology per session).
Physician Associate
AKH Inc., Advancing Knowledge in Healthcare has been authorized by the American Academy of Physician Associates (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 8.0 AAPA Category 1 CME credits per session.
PAs should only claim credit commensurate with the extent of their participation.
Pharmacists
AKH Inc., Advancing Knowledge in Healthcare designates this continuing education activity for 8.0 contact hours per session.
Commercial Support
This activity is supported from an independent medical education grant from BTG international lnc.,
Disclosures
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with ineligible companies whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are mitigated by AKH prior to accreditation of the activity. AKH planners and reviewers have no relevant financial relationships to disclose.
Disclosure of Unlabeled Use and Investigational Product
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participants misunderstanding of the content. If you would like to opt out from future communications from AKH please send an email to optout@akhcme.com with your information with "Opt Out" in the subject line.
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Contains 6 Component(s), Includes Credits Includes a Live Web Event on 11/15/2024 at 8:50 AM (EST)
Methemglobinemia, Heavy metals, Hydrocarbons, Ethanol, Methanol, Marine, Reptiles, Arthropods, Mushrooms, Herbicides, insecticides and more!
#TotalTox2024
The last live, virtual session of the Total Tox Course will focus on Non-Pharmaceuticals.
This session will include discussions of toxicology of plants and mushrooms, and reptile, marine, and arthropod envenomations. Experts will also cover anesthetic toxicity, malignant hyperthermia, and methemoglobinemia. Gain expertise in managing heavy metal poisoning and the complexities of ethanol and toxic alcohol intoxication. Participate in interactive case panels on novel treatments for critically ill patients and evaluation of an unknown potential toxicology issue, bringing together all your knowledge from the Total Tox Course.
Learner Objectives
After attending the event, participants should be able to:
- Identify non-pharmaceutical poisons found in various locations including home, cabinet, garage, and yard.
- Discuss current and emerging management options for ethanol intoxication, withdrawal, and use disorder.
- Examine other toxicological concerns including heavy metals, methemoglobin-forming agents, toxic hyperthermia, and venomous creatures
Questions?
Please write to ACMT at events@acmt.net
Agenda | Session 3 - November 15, 2024
8:50 - 9:00 AM ET | Opening Remarks
9:00 - 9:30 AM ET
Hospital Hazards #1: Anesthetic Toxicity & Malignant Hyperthermia
Shaun D. Carstairs, MD, FACMT Medical Toxicologist, 98point6, Inc., Seattle, WADr. Carstairs will discuss the history and pharmacology of local anesthetics and the unique characteristics and common clinical use for each prototypical local anesthetic. He will assess the most commonly caused several complications of local anesthetics and identifies general thermoregulatory principles. He will also review the following hyperthermic syndromes & discusses treatment options: Serotonin Syndrome, Neuroleptic Malignant Syndrome, and Malignant Hyperthermia.
9:30 - 10:00 AM ET
Hospital Hazards #2: Methemoglobinemia
Andrea Carlson, MD Emergency Medicine Physician, Advocate Christ Medical Center, Oak Lawn, ILDr. Carlson will discuss the common agents causing Methemoglobinemia. She will identify methemoglobinemia mechanisms of toxicity and describe the best practices in clinical management of methemoglobinemia.
10:00 - 10:30 AM ET
Heavy Metals In the ED: Lead, Arsenic & Mercury
Evan Schwarz, MD, FACMT, FASAM, FACEP Medical Toxicology Fellowship Director, University of California, Los Angeles, Los Angeles, CADr. Schwarz will review the signs and symptoms of lead toxicity. He will discuss the role of chelation in heavy metal toxicity and compare and contrast the toxicity caused by different forms of mercury.
10:30 - 10:45 AM ET | Break (15 min)
10:45 - 11:45 AM ET
Case Panel: Novel Treatments for the Crashing PatientSeveral speakers from previous lectures will return to review clinical cases.
11:45 - 12:30 PM ET
Ethanol Intoxication: Too Much Of a Good Thing
Anthony Pizon, MD, FACMT Chief of Medical Toxicology Division, Professor of Emergency Medicine, University of Pittsburgh, Pittsburgh, PADr. Pizon will examine the prevalence of ethanol AUD in patients presenting to the Emergency Department. He will also discuss the genetic vs. environmental factors for ethanol AUD and assess the most critical laboratory tests for symptomatic patients who have suspected ethanol intoxication.
12:30 - 1:15 PM ET
When It's Not Ethanol: Demystifying Toxic Alcohols
Bram Dolcourt, MD Clinical Assistant Professor Department of Emergency Medicine, Wayne State University, Detroit, MIDr. Dolcourt will describe toxicity & time course of methanol (MeOH) and ethylene glycol (EthGly) exposures, identify two stand-in tests for MeOH and EthGly, noting limitations, and present a rationale for treatment with ethanol, fomepizole, and/or hemodialysis.
1:15 - 1:45 PM ET | Break (30 min)
1:45 - 2:15 PM ET
Ethanol Withdrawal: When the Good Times End
Jerrold Blair Leikin, MD, FACP, FACEP, FACMT, FAACT, FACOEM, FASAM Adjunct Clinical Professor Division of Environmental and Occupational Health Sciences & Professor of Medicine, University of Illinois Chicago and Rosalind Franklin University of Medicine & Science, North Chicago, ILDr. Leikin will discuss appropriate treatment so that complications are prevented. He will examine alcohol withdrawal symptoms and describe the principles of detoxification.
2:15 - 2:45 PM ET
Don't Touch That! Marine, Arthropod & Reptile Envenomations
Michael Levine, MD, FACMT Associate Professor of Emergency Medicine, University of California Los Angeles, Los Angeles, CADr. Levine will identify various toxic envenomations and describe the characterization of Black Widow envenomation and management options. He will also discuss management options for pit viper envenomations.
2:45 - 3:15 PM ET
The Toxic Yard
Fiona Garlich Horner, MD Head of Toxicology & Assistant Professor of Clinical Emergency Medicine, LAC+USC Medical Center & University of Southern California Keck School of Medicine, Los Angeles, CADr. Garlich Horner will examine different classes of plant derived toxins and their effects on humans and identify hazards of different mushrooms and clinical toxidromes associated with mushrooms.
3:15 - 3:45 PM ET
The Toxic House
Ashley Haynes, MD, FACEP Medical Director, Addiction Toxicology of Kansas, Wichita, KSDr. Haynes will discuss common household exposures and their implications and review the toxicity of common household cleaners and toys.
3:45 - 4:00 PM ET | Break (20 min)
4:00 - 4:30 PM ET
The Toxic Cabinet
Stephen Wood, MS, ACNP-BC, FEWM Acute Care Nurse Practitioner & Director of Advanced Practice Providers, St. Elizabeth’s Medical Center, Brighton, MANurse Practitioner Wood will review toxicity of essential oils and examine the risks associated with the use of dietary supplements.
4:30 - 5:00 PM ET
The Toxic Garage
Andrew King, MD Associate Professor in the Department of Emergency Medicine & Medical Director, Wayne State University School of Medicine & Michigan Poison and Drug Information Center, Detroit, MIDr. King will discuss common toxins and exposures of chemicals commonly found in the garage. He will also review toxicity and management of chemicals and other substances commonly found in the garage.
5:00 - 5:30 PM ET
Case PanelSeveral speakers from previous lectures will return to review clinical cases.
Andrea Carlson, MD
Emergency Medicine Physician
Advocate Christ Medical Center
Dr. Andrea Carlson is an attending physician in Emergency Medicine at Advocate Christ Medical Center in Oak Lawn, IL, where she has served the patients of Chicago's South Side for 25 years. She is also the Director of Medical Toxicology, and the Associate Program Director of the Advocate Christ Emergency Medicine Residency. Her primary academic interests lie in toxicology education and critical care toxicology.
Shaun D. Carstairs, MD, FACMT
Medical Toxicologist
98point6, Inc.
Dr. Carstairs earned his undergraduate degree from the California Institute of Technology in Pasadena, CA and received his medical degree from the Uniformed Services University of the Health Sciences (USU), the nation's military medical school. He completed a residency in emergency medicine at the Naval Medical Center in San Diego and a fellowship in medical toxicology at the University of California, San Diego. He served more than 25 years on active duty in the U.S. Navy, which included a combat deployment to Iraq and shipboard deployment as the leader of a mobile trauma team for the Navy’s Pacific Fleet. He retired from the Navy as a Captain in 2019. He currently serves as a faculty member in the Department of Emergency Medicine & Division of Medical Toxicology at the University of California, San Diego (UCSD). In addition to his role at UCSD, he holds an appointment as Professor of Military & Emergency Medicine at USU.
Bram Dolcourt, MD
Clinical Assistant Professor Department of Emergency Medicine
Wayne State University
Bram Dolcourt is Assistant Professor of Emergency Medicine at Wayne State University and serves as Associate Residency Director for Emergency Medicine at Sinai Grace Hospital in Detroit. Dr. Dolcourt is a Clinical Consultant to the Michigan Poison and Drug Information Center. Dr Dolcourt complete Medical School at New York Medical College and residency at Henry Ford Hospital. Dr. Dolcourt then went on to complete fellowship in Medical Toxicology at the Children’s Hospital of Michigan. Dr. Dolcourt’s interests include inpatient addiction medicine and heavy metal exposures.
Ashley Haynes, MD, FACEP
Medical Toxicologist, Addiction Medicine Specialist
Veterans Health Administration
Dr. Haynes completed training in a combined emergency medicine-internal medicine program in 2014, and a toxicology fellowship at UTSW in 2016. She has been treating substance use disorders as part of her practice since that time and is board certified in addition medicine. She currently works for the VA at the Robert J Dole Veterans Medical Center in Wichita, KS, treating patients in a residential treatment center, as well as clinic, and performing bedside consults.
Fiona Garlich Horner, MD
Head of Toxicology & Assistant Professor of Clinical Emergency Medicine
LAC+USC Medical Center & University of Southern California Keck School of Medicine
Dr Fiona Garlich Horner is the Head of Medical Toxicology at Los Angeles County + University of Southern California (LAC+USC) Medical Center, and an Assistant Professor of Clinical Emergency Medicine at the University of Southern California Keck School of Medicine. She is a graduate of Oregon Health Sciences University School of Medicine in Portland, Oregon, and completed her residency in Emergency Medicine at Hennepin County Medical Center in Minneapolis, Minnesota. After completing a fellowship in Medical Toxicology at New York University and the New York City Poison Control Center, she served as an attending emergency physician and medical toxicologist with the Poison and Drug Information Service (PADIS) in Calgary, Alberta, Canada.
Dr. Garlich is now an attending emergency physician and medical toxicologist at LAC+USC Medical Center in Los Angeles, California, one of the largest and busiest public hospitals in the United States. She is the director of the inpatient toxicology consultation service and the resident toxicology rotation, as well as the chair of the hospital’s medication safety committee. Her primary academic interests lie in toxicology education and advancing the care of vulnerable and incarcerated populations.
B. Zane Horowitz, MD, FACMT
Associate Medical Director
Oregon Poison Center
Dr. B. Zane Horowitz served as the medical director of the Oregon-Alaska-Guam Poison Center for 22 years. He also served as the medical director for the Utah Poison Control Center for 7 of those years. He currently continues to teach at Oregon Health and Science University in medical toxicology, and has authored over 90 publications.
Andrew King, MD
Associate Professor in the Department of Emergency Medicine & Medical Director
Wayne State University School of Medicine & Michigan Poison and Drug Information Center
Dr. King is an Emergency medicine physician, Medical Toxicologist and Addiction Medicine specialist at the Detroit Medical Center and Wayne State University. He works as an emergency physician at Sinai Grace and Detroit Receiving Hospitals. He additionally works at the Tolan Park Research Center where he sees patients with substance use disorders. He is the interim director of the Michigan Poison and Drug Information Center and the Fellowship Director of the Medical Toxicology Fellowship. He is excited to be an organizer and presenter at the Total Tox Course!
Jerrold Blair Leikin, MD, FACP, FACEP, FACMT, FAACT, FACOEM, FASAM
Adjunct Clinical Professor Division of Environmental and Occupational Health Sciences & Professor of Medicine
University of Illinois Chicago and Rosalind Franklin University of Medicine & Science
I am a currently Adjunct Clinical Professor on the Division of Environmental and Occupational Health Sciences and the Occupational and Environmental Medicine Service of UI Health at the University of Illinois at Chicago and Professor of Medicine at Rosalind Franklin University of Medicine & Science in North Chicago, Ill.
In 1980, I received my medical degree from the Chicago Medical School. I then completed a combined residency in Internal Medicine and Emergency Medicine at Northwestern University (1984) followed by a three-year preceptorship/fellowship training in Medical Toxicology at Cook County Hospital and University of Illinois Hospital in Chicago, Illinois. I am Board Certified in Internal Medicine, Emergency Medicine, Medical Toxicology and Addiction Medicine.
I served as the Associate Director of the Emergency Department at Rush Presbyterian-St. Luke’s Medical Center in Chicago from 1998-2001. During this time, I was also the Medical Director of the Rush Poison Control Center and served as Medical Director of the United States Drug Testing Laboratory (from 1991 -1996). I was also the Medical Director of PROSAR (located in St. Paul, MN); a national call center devoted to industrial exposures and product safety issues, up until December 2013.
I have presented over 200 research abstracts at national meetings (primarily to the North American Congress of Clinical Toxicology) and have published over 200 articles in peer-reviewed medical journals. I am the co-editor of the Poisoning and Toxicology Handbook (now in its fourth edition), published by CRC Press, and the American Medical Association Handbook of First Aid and Emergency Care, and published by Random House (New York). I am also the co-editor with Dr. Robin McFee for the Toxico-terrorism book (McGraw Hill) and the Handbook of Nuclear, Biological and Chemical Agent Exposure (CRC Press) both published in 2007. I was also the co-editor of the American Medical Association Complete Medical Encyclopedia, published by Random House in 2003. I am presently the Editor-in-Chief of the primary care journal, Disease-a-Month, published by Elsevier. I was on the Illinois State Board of Health from 2016 – 2019.
Michael Levine, MD, FACMT
Co-Division Chief of Medical Toxicology
University of California, Los Angeles
Michael Levine is a Los Angeles native, who completed his emergency medicine residency at the Harvard Affiliated Emergency Medicine program, based out of Brigham and Women’s Hospital and Massachusetts General Hospital. After residency, he completed his medical toxicology fellowship at Banner Good Samaritan Medical Center in Phoenix, AZ. After staying as faculty for a year in Phoenix, he moved back to Los Angeles, where he joined the faculty at USC. He is currently the division chief of medical toxicology. He is actively involved in patient care, research, and serves on numerous hospital and university committees. He is an active member of American College of Emergency Physicians, the American College of Medical Toxicology, and is a member of the Toxicology Investigator's Consortium.
Howard McKinney, PharmD, DABAT, FAACT
Secretary-Treasurer
American Board of Applied Toxicology & North American Society of Toxinology
Dr McKinney graduated in 1971 from the University of California San Diego, Revelle College with a Bachelor of Arts degree (BA), Biology major, Spanish Literature minor.
In 1978 he graduated from UCSF School of Pharmacy with a Doctor of Pharmacy degree (PharmD), and was recruited to be a founding staff member of the San Francisco Poison Center, where he worked until 1992.
In 1992 he passed the Boards to become a Diplomate of the American Board of Applied Toxicology DABAT), and was hired as a Clinical Pharmacist in Critical Care at Univ Calif Davis Medical Center in Sacramento California (UCDMC).
In 2018 he was approved as a Fellow of the American Academy of Clinical Toxicology (FAACT), and retired from UCDMC. He continues his work as Secretary-Treasurer of ABAT and NAST (North American Society of Toxincology), as well as his love of herpetology, hiking, photography, videography and music.
Anthony Pizon, MD, FACMT
Chief of Medical Toxicology Division, Professor of Emergency Medicine
University of Pittsburgh
Dr. Anthony (Tony) Pizon received his medical degree from the University of Toledo School of Medicine in 2001. He then completed his Emergency Medicine Residency at the University of Pittsburgh Medical Center in 2004 and his Medical Toxicology Fellowship at Banner Good Samaritan Medical Center in Phoenix, Arizona in 2006. Dr. Pizon is currently a Professor in the Department of Emergency Medicine, Division of Medical Toxicology at the University of Pittsburgh, School of Medicine. He serves as Chief of the Division of Medical Toxicology and Director of the Medical Toxicology Fellowship at UPMC. He is also Assistant Medical Director of both the Pittsburgh and West Virginia Poison Centers. Yet, most importantly, he is blessed with amazing wife, Caryn, and four wonderful children (Benjamin, Elizabeth, Gabriela, and Seraphina).
Evan Schwarz, MD, FACMT
Associate Professor of Emergency Medicine
University of California, Los Angeles
Dr. Schwarz attended medical school at the University of Texas Medical Branch in Galveston, Texas, before completing a residency in Emergency Medicine at the Washington University School of Medicine in Saint Louis, Missouri. After residency, he completed a fellowship in Medical Toxicology at the University of Texas Southwestern School of Medicine in Dallas, Texas, before returning to Missouri where he was an Advisory Dean and the Medical Toxicology Division Chief and Fellowship Director at Washington University. In 2023, he took a position in the Department of Emergency Medicine at the University of California Los Angeles. He is also a member of the Board of Directors for ACMT.
Donna Seger, MD, FAACT, FACMT
Professor Emeritus
Department of Medicine, Vanderbilt University Medical Center
Donna Seger, MD, retired in December 2021 after working for 33 years at Vanderbilt University Medical Center and the Tennessee Poison Center (TPC). Dr. Seger began her career at VUMC in 1988 in the Department of Emergency Medicine, becoming professor of Clinical Medicine and Emergency Medicine. She served as medical and executive director of the Tennessee Poison Center from 1990-2021. Seger received her undergraduate and medical degrees from University of North Dakota, Grand Forks. She completed her residency in emergency medicine and a fellowship in toxicology at the University of Cincinnati. Seger taught toxicology courses at Vanderbilt and developed consulting services and toxicology rotations for emergency medicine and pediatric residents and fellows and pediatric emergency medicine fellows. She was the first female president of the American Academy of Clinical Toxicology (AACT) and received its Career Achievement Award and Distinguished Service Award for her achievements in the field of toxicology. While retired from active clinical practice, she plans to remain active in the toxicology community.
Stephen Wood, MS, ACNP-BC, FEWM
Acute Care Nurse Practitioner & Director of Advanced Practice Providers
St. Elizabeth’s Medical Center
Stephen P. Wood is an acute care nurse practitioner and director of advanced practice providers in the division of pulmonary and critical care medicine at St. Elizabeth’s Medical Center. Prior to this he spent 11 years practicing as a nurse practitioner in emergency medicine. His roots are in EMS and he has over 30 years of field experience, including 10 as a flight paramedic. He is an instructor in the School of Nursing at Northeastern University in the graduate nursing program and is a graduate scholar of the Harvard Macy Institute program for Healthcare Educators. He is a former fellow in Bioethics at the Center for Bioethics at Harvard Medical School and a current visiting researcher at the Petrie-Flom Center at the Harvard Law School Petrie-Flom Center for Health Policy. He holds a Master of Science in Nursing as well as a Master of Science in Toxicology. He is the Director of Field Operations for World Extreme Medicine USA and host of the WEM podcast.
Registration Rates
Registration includes:
- Access to the live virtual event on November 15, 2024
- Access to the on-demand recording for 90 days after the event
- Access to the Speaker slides
- 8.00 Continuing Education Certificate. Available credits: Continuing Medical Education (CME), Continuing Nursing Education (CNE), Continuing Pharmacy Education (CPE), Continuing Medical Education for Physician Associates (AAPA CME), and Continuing Education for Nurse Practitioners (AANP CE).
Are you a member of any of the following organizations? AAEM, AAENP, APAMT, APC, EAPCCT, SOT, MENATOX
You may be eligible for a registration discount! Please email us at events@acmt.net to find out more.Member Rates
Member Tier I: Full, Affiliate, International, Emeritus
$200
Member Tier II: Fellows
$200
Member Tier III: Residents, International - Developing Country
$125
Member IV: Medical Students
$75Non-Member Rates
Non-member Tier I: Physicians, Pharmacists, Lawyers, "Other"
$225
Non-member Tier II: Fellows, SPIs, Nurses, etc.
$225
Non-member Tier III: Educators & Emergency Responders
$150
Non-member IV: Residents & Students
$100
ACMT Membership
ACMT Members receive a discounted rate. Interested in becoming an ACMT Member? Contact our Membership Team at membership@acmt.net. Learn more at: www.acmt.net/membership
Package Rates
Sign up for the all three days of the 2024 ACMT Total Tox Course and save $100!
Refunds and Cancellations
- Cancellations made 15 days or more in advance of the event date will receive a full refund less a 8% processing fee.
- Cancellations made within 14 days of the event date will not receive a refund.
All cancellation requests must be made in writing and emailed to: events@acmt.net. No telephone cancellations will be accepted. A refund that results from a cancellation or change to your registration will be returned to the original payer and in the original method of payment.
Pending review, limited exceptions will be made based on need and circumstance (family emergency, for example) and must be submitted in writing to events@acmt.net. For these instances, the full registration fee, minus a 8% processing fee, will be refunded. Because each exception must undergo a review and approval process, we ask in advance for your patience.
Questions?
For any questions, please email us at events@acmt.net.
Instructions
Once you have completed your registration:
- Click on the Contents tab on the day of live event. This is where you will be able view the Zoom link for the course as well as all required components.
- Complete the Pre-Test. For best the best learning experience, please complete this before the live event on November 1, 2024.
- Watch live event. You can use the Zoom link in the Learning Center to leave and enter the webinar during event.
- Complete the Post-Test. These questions are based on content from the lectures to gauge your comprehension of the lectures. It requires a 80% to pass.
- Complete the Event CE Survey. If you are completing CE, this survey is required.
- Claim your CE certificate. Once you have claimed your CE credit, you will not be able to change your CE certificate.
Full credit can only be claimed after completion of all required components.
Hardware/Software Requirements
Computer or Other Internet-Enabled Device; Internet Connection; Browser.
Materials
None.
Prerequisites
None.
Format
This event is a live Webinar with CME, CNE, CPE, AAPA CME, and AANP CE.
Need Assistance or Have Questions?
For assistance logging in, accessing content, purchasing or completing Continuing Education credits, or for other questions, please contact us at events@acmt.net or visit our FAQ page.
If you are in need of accessible learning accommodations, please contact events@acmt.net for additional assistance.
Continuing Education
2024 ACMT Total Tox Course – Non-Pharmaceuticals
Live Webinar
Friday November 15, 2024CE credit provided by AKH Inc., Advancing Knowledge in Healthcare.
Criteria for Success
There is no fee to participate in this activity. Certificate of completion will be awarded based on the participant's attendance. A certificate of completion will be available upon completion of an online evaluation/claim credit form available at: https://education.acmt.net/p/2024TTC-Non-PharmPlease claim your credit by December 15, 2024
If you have questions about this CE activity, please contact AKH Inc at bethany@akhcme.com
In support of improving patient care, this activity has been planned and implemented by AKH Inc., Advancing Knowledge in Healthcare and American College of Medical Toxicology (ACMT). AKH Inc., Advancing Knowledge in Healthcare is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
This activity was planned by and for the healthcare team, and learners will receive 8.0 Interprofessional Continuing Education (IPCE) credit for learning and change.
In support of improving patient care, this activity has been planned and implemented by AKH Inc., Advancing Knowledge in Healthcare and American College of Medical Toxicology (ACMT). AKH Inc., Advancing Knowledge in Healthcare is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
This activity was planned by and for the healthcare team, and learners will receive 8.0 Interprofessional Continuing Education (IPCE) credit for learning and change.
Physicians
AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 8.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Nurses
Credit being awarded: 8.0 ANCC contact hours.Nurse Practitioners
This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and American College of Medical Toxicology (ACMT). AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 030803. This activity is approved for 8.0 contact hour(s) (which includes 8.0 hour(s) of pharmacology).
Physician Associate
AKH Inc., Advancing Knowledge in Healthcare has been authorized by the American Academy of Physician Associates (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 8.0 AAPA Category 1 CME credits.
PAs should only claim credit commensurate with the extent of their participation.
Pharmacists
AKH Inc., Advancing Knowledge in Healthcare designates this continuing education activity for 8.0 contact hour
Commercial Support
This activity is supported from an independent medical education grant from BTG international lnc.,Disclosures
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with ineligible companies whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are mitigated by AKH prior to accreditation of the activity. AKH planners and reviewers have no relevant financial relationships to disclose.Disclosure of Unlabeled Use and Investigational Product
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.Disclaimer
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participants misunderstanding of the content. If you would like to opt out from future communications from AKH please send an email to optout@akhcme.com with your information with "Opt Out" in the subject line.