Tox Tunes #113: Legend of a Mind (Moody Blues)
“Legend of a Mind” is about Timothy Leary, the one-time Harvard professor of psychology and 1960s LSD-mountebank Timothy Leary, whom Richard Nixon once called the “most dangerous man in America.”
Timothy Leary’s Dead
No, no, he’s outside looking in
He’ll fly his astral plane
Takes you trips around the bay
Brings you back the same day
Timothy Leary, Timothy Leary
Despite this funereal first verse, the song long pre-dated Leary’s death in 1996, and appeared on The Moody Blues 1968 progressive rock album In Search of the Lost Chord. “Legend of a Mind” was written by...
Source: The Poison Review - January 15, 2018 Category: Toxicology Authors: Leon Gussow Tags: Medical In search of the lost chord Legend of a Mind Moody Blues Ray Thomas Timothy Leary tox tunes Source Type: news
Fatal ingestion of e-cigarette nicotine liquid
lucadp/shutterstock.com
2.5 out of 5 stars
Death from Ingestion of E-Liquid. Morley S et al. J Emerg Med 2017 Dec;53:862-864.
Abstract
This short case report is presented in a somewhat confusing fashion but nevertheless brings up interesting points.
A 32-year-old man was brought to hospital after having a cardiac arrest in the field 1 hour after ingesting approximately 20 ml of e-cigarette nicotine liquid containing 72 mg/ml of nicotine (total dose approximately 1440 mg.) He was resuscitated but had developed anoxic encephalopathy and died 3 days later. A plasma nicotine level drawn 24 hours after admission was 1600 ng/ml...
Source: The Poison Review - January 9, 2018 Category: Toxicology Authors: Leon Gussow Tags: Medical e-cigarette liquid fatality liquid nicotine toxicity Source Type: news
The 8th Annual Alexander Awards: The Best Tox Reading of 2017
Alexander Gettler
Once again, last year’s outstanding examples of long-form journalism dealing with topics related to medical toxicology were dominated by coverage of the opioid crisis, its origins and the resulting carnage.
The must-read article of the year was “The Family That Built a Empire of Pain,” Patrick Radden Keefe’s massive history of the Sacklers, one of America’s richest clans, much of whose wealth comes from their ownership of Purdue Pharma and the marketing and distribution of Oxycontin.
The article, which appeared in the New Yorker, notes that the clan’s patriarch, Arthur...
Source: The Poison Review - January 2, 2018 Category: Toxicology Authors: Leon Gussow Tags: Medical 2017 Alexander awards opioids Purdue Pharma Sackler Source Type: news
Is there a better way to administer IV N-acetylcysteine?
3 out of 5 stars
Fewer adverse effects with a modified two-bag acetylcysteine protocol in paracetamol overdose. McNulty R et al. Clin Toxicol 2017 Dec 8 [Epub ahead of print]
Abstract
Current recommendations for dosing intravenous N-acetylcysteine (Acetadote) for treating acute acetaminophen (paracetamol) poisoning involves a somewhat complex three-bag protocol, using 3 direct concentrations of the antidote given over a 21-hour period. Unfortunately, this protocol results in a high incidence of (usually mild) adverse events, including cutaneous effects, nausea and vomiting, and anaphylactoid reactions. Severe reactions s...
Source: The Poison Review - December 14, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical Acetadote acetaminophen antidote N-acetylcysteine paracetamol three-bag protocol toxicity two-bag protocol Source Type: news
Case series: treating cannabinoid hyperemesis syndrome with capsaicin cream
3 out of 5 stars
Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series. Dezieck L et al. Clin Toxicol 2017 Sep;55:908-913.
Abstract
Cannabis hyperemesis syndrome (CHS) is a form of cyclic vomiting characterized by:
chronic marijuana use
recurrent vomiting, and
lack of alternate explanation for symptoms
A striking feature is that although CHS-induced nausea and vomiting are frequently resistant to standard antiemetics such as ondansetron, patients often report that very hot showers or baths relieve their symptoms. Several years ago, Jeff Lapoint noticed that the...
Source: The Poison Review - December 5, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical cannabinoid hyperemesis syndrome capsaicin treatment TRPV1 receptor Source Type: news
Tox Tunes #112: Chinese Rocks (Johnny Thunders & the Heartbreakers)
In a recent article discussing his favorite songs, food/travel guru Anthony Bourdain comments: “My early honeymoon period with heroin; this song made an other ill considered lifestyle option seem like a good idea.”
Bourdain probably wasn’t paying close attention to the lyrics, which describe something other than a wise personal choice:
I’m living on a Chinese Rock
All my best things are in hock
I’m living on a Chinese Rock
Everything is in the pawn shop
“Chinese Rock” is heroin. According to a commenter on Genius.com, there was an alternate third verse that the Heartbreakers someti...
Source: The Poison Review - December 4, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical chinese rocks Dee Dee Ramone heroin Johnny Thunders & the Heartbreakers Richard Hell tox tunes Source Type: news
Decontamination following deliberate mass-casualty exposures
[wikipedia.org]4 out of 5 stars
Decontamination. Houston M, Hendrickson RG. Crit Care Clin 2005:21:653-672.
Abstract
Looking to finish some Lifelong Learning and Self-Assessment (LLSA) tests before the end of the year so I can re-certify in emergency medicine, I discovered that the subspecialty Medical Toxicology reading list modules can be used to comply with these requirements. At this time there are 3 active toxicology reading lists: 2017, 2015 and 2013. In the coming weeks, I will review selected articles from these lists.
This review comes from the October 2005 issue of Critical Care Clinics, which covered the g...
Source: The Poison Review - November 29, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical biological chemical decontamination lifelong learning and self-assessment LLSA nuclear radiological terrorism weapon Source Type: news
Are ibuprofen plus acetaminophen as good as opioids in treating acute extremity pain
3.5 out of 5 stars
Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial. Chang AK et al. JAMA 2017;318:1661-1667.
Abstract
As Dr. Demetrios Kyriacou points out in a must-read editorial accompanying this paper, a growing body of evidence clearly indicates that even short-term opioid use for painful injuries or procedures carries a significant risk of leading to chronic use and potential abuse. We are now realizing the importance of avoiding even limited use of drugs such as oxycodone and hydrocodone in opioid-naive patients, if at ...
Source: The Poison Review - November 22, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical acute pain analgesic emergency department opioid Source Type: news
Absolute must-watch: 60 Minutes on how pharmaceutical distributors fueled the opioid crisis
In a blockbuster investigation carried out along with the Washington Post, 60 Minutes’ Bill Whitaker looks into allegations that powerful pharmaceutical distributors helped advance the current opioid crisis by fulfilling patently suspicious orders for prescription opioids. The piece cites one example where a pharmacy in a West Virginia town with a population of several hundred ordered and received millions of opioid pills.
The main source for the piece is Joe Rannazzisi, former head of the Drug Enforcement Agency’s Office of Diversion Control. Rannazzisi charges that as his office was planning to prosecute some...
Source: The Poison Review - October 16, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical 60 minutes DEA drug enforcement agency opioid crisis washington post Source Type: news
Tox Tunes #111: Girl on LSD (Tom Petty)
Although this Tom Petty song is somewhat obscure, I’m embarrassed to say I hadn’t know about it until an article in The Cannabist after the singer’s death last week brought it to my attention. The song appeared as the B-side to “You Don’t Know How It Feels” and was scheduled to be on Petty’s 1994 album Wildflowers, but the record company (Warners) objected because of its content.
The New York Times has posted a guide with links to 14 essential Petty tracks. By the way, in a brilliant cold open to “Saturday Night Live” yesterday following the mass shooting tragedy in...
Source: The Poison Review - October 9, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical girl on LSD tom petty tox tunes Source Type: news
ACMT Position Statement: Toxicology Issues in Determining Brain Death
4 out of 5 stars
ACMT Position Statement: Determining Brain Death in Adults After Drug Overdose. Neavyn MJ et al. J Med Toxicol 2017;13:271-273.
Full Text
The American Academy of Neurology guidelines on determining brain death in adults states that the clinician can not make such a determination unless he or she can “[e]xclude the presence of a CNS-depressant drug effect by history, drug screen, calculation of clearance using 5 times the drug’s half-life (assuming normal hepatic and renal function), or, if available, drug plasma levels below the therapeutic range.”
Excluding drug effect in these cases...
Source: The Poison Review - September 27, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical american college of medical toxicology baclofen brain death position statement Source Type: news
Organic psychosis and nystagmus? consider dextromethorphan toxicity
2 out of 5 stars
Dextromethorphan in Cough Syrup: The Poor Man’s Psychosis. Martinak B et al. Psychopharmacol Bull 2017 Sep 15:47:59-63.
Full Text
Dextromethorphan (DXM) is found in many over-the-counter cough and cold medications. At recommended therapeutic dosage (up to 120 mg per day in divided doses) DXM is safe and has no psychiatric effects. However, DXM and its major metabolite —dextrorphan — act as NMDA receptor antagonists, producing effects similar to those of phencyclidine (PCP) or ketamine when taken in large amounts.
The intensity of psychiatric symptoms seen after DXM overdose is dose-dependent. ...
Source: The Poison Review - September 26, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical cough and cold medicine dextromethorphan ketamine over-the-counter phencyclidine Source Type: news
Fentanyl, carfentanil and the opioid crisis: where do we stand now?
3.5 out of 5 stars
Controversies and carfentanil: We have much to learn about the present state of opioid poisoning. Cole JB, Nelson LS. Am J Emerg Med 2017 Aug 24 [Epub ahead of print]
Reference
I have argued — both in a post on this blog and a column in Emergency Medicine News — that the idea of a “heroin overdose” is a completely outdated concept that is never coming back. The fact is, when a patient comes in today with a history of shooting or snorting heroin, none of us have any firm idea about exactly what drug or drugs were involved. The chance that such a patient was exposed only to heroin is virtua...
Source: The Poison Review - September 19, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical carfentanil fentanyl opiates opioids Source Type: news
Great New Toxicology Podcast
In the first episode of “The Dantastic Mr. Tox & Howard Show,” Drs. Dan Rusyniak and Howard Greller — formerly of the Journal of Medical Toxicology Podcast — have a superb discussion about the current expanding opioid crisis with Dr. David Juurlink from Sunnybrook Health Sciences Centre in Toronto. Topics covered include opioid-induced hyperalgesia, the key difference between relieving pain and relieving suffering, and why tramadol is generally such a poor drug. The episode is smart, succinct, and highly recommended. I look forward to future podcasts. To listen, click here. You can also subscribe ...
Source: The Poison Review - June 16, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical daniel rusyniak dantastic mr. tox & howard david juurlink howard greller podcast Source Type: news
Episode #15: How easy is it to get addicted to opioids?
TPR PODCAST EPISODE #15: HOW EASY IS IT TO GET ADDICTED TO OPIOIDS?
As has been well reported in medical papers, government studies and popular media, rates of overdose deaths from opioids have been increasing steadily over the last several decades. A recent article in the New York Times reported that there were likely more than 59,000 drug overdose deaths in 2016, an estimated 19% increase over the number in 2015. The total for 2017 is likely to be even higher.
Many deaths have been associated with prescription opioid analgesics, or have occurred among patients who became addicted to prescription opioid analg...
Source: The Poison Review - June 11, 2017 Category: Toxicology Authors: Leon Gussow The Poison Review Tags: Podcast Source Type: news
