Sunday, October 23, 2005

Lecture: Toxicology: Antipsychotics and Opioids

You can listen to Dr. Kolecki's lecture by clicking above or you may subscribe to our podcast by searching for "Jefferson" in iTunes under podcasts.

Antipsychotics and Opioids
- Alex

Sunday, October 16, 2005

CO Poisoning

That was a good case by Neil below.

A study in Annals showed that venous measurements of CO level accurately reflect arterial levels. Ann Emerg Med. 1995 Apr;25(4):481-3.

I will make the follow comments advocating arterial blood sample, though:

1. Few patients in the above study had high CO levels (>20%)
2. Pulse oximeter will give falsely elevated O2 sat values even in cases of extremely high COHb levels (Ann Emerg Med. 1994 Aug;24(2):252-5). In the setting of concomitant hypoxia (smoke inhalation), only an arterial sample will give an accurate measurement of arterial oxygen content when measured by lab CO-oxymetry Chest. 1998 Oct;114(4):1036-41.
3. ABG will allow evaluation for metabolic acidosis, which is very important, as several studies have shown that the degree of acidosis is a better predictor of severity than absolute CO level. J Accid Emerg Med. 1999 Mar;16(2):96-8 This is partially b/c CO also binds intracellular cytochromes needed for oxidative metabolism.

Saturday, October 15, 2005

CO Poisoning

Case Summary: A daughter, mother and grandaughter present to Jeff ED c/o nausea, lightheadedness, vomiting, and headache for several hours. The CO Monitor at home went off this afternoon s/p the furnace was turned on for the first time this morning.

DX: CO Poisoning


1) Start pt on 100% High Flow Oxygen Mask.
2) Draw carboxy hemoglobin levels

Results/TX/What I learned:

The patients carboxy levels were elevated-- 10%, 22%, and 36% for D, Mom, and Grand Mom, respectively. CO levels can be elevated in smokers (10% is nml). CO has a half life of 4-8 hours. With high flow o2 mask, this half life is reduced to 60 mins. (with hyperbaric 02 chamber, halflife is reduced to 23 mins) Pts were left on mask for 2 hours, and then D/C'd. Common symptoms with CO exposure include lightheadedness, headaches, N/V. Blood venous PO2 measurements tend to be normal, because PO2 reflects O2 dissolved in blood and this process not affected by CO. In contrast, hemoglobin-bound O2 (which normally comprises 98 percent of arterial O2 content) is profoundly reduced in the presence of COHb. In this case, venous blood was sent.

Sunday, October 02, 2005

Case: Opisthotonos

19 yo male presents with neck spasms, back spasms and trismus after ingesting several unknown pills 2 days ago and smoking crack today.
VS: HR 170's, BP: 150/100
PE: Young male in severe distress with neck and back in full extension, unable to relax muscles
ER course: Treated with IV ativan, benadryl and cogentin with full relief of symptoms
What we learned: Opisthotonos has a wide differential, including tetanus, dystonic reaction (from meds like compazine), intracranial hemorrhage, strychnine, meningitis.
-Neil and Alex