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Josh Trebach, MD

Dec 30, 2022 • 9 tweets • 2 min read

A family of five arrives to the emergency department with "the flu." They all have headache, nausea, vomiting, and generally feel unwell. You are about to discharge them when they let you know that even their dog is sick with "the flu"!

What do you think is going on? 🤔☠️

This time of year can be tricky...because CARBON MONOXIDE toxicity can mimic things like the flu or a viral illness.

Carbon monoxide is an odorless, tasteless, invisible gas that comes from things like automobile exhaust, fires, fuel-burning heaters, gas stoves, generators, etc.

More than 1/3rd of deaths from carbon monoxide in the United Sates occur during winter months. Clusters of carbon monoxide cases are associated with ice storms/blizzards/hurricanes probably because people are crowded inside and using fuel-burning items.

Carbon monoxide can also diffuse through drywall (sometimes drywall is very porous) so your neighbors and people around you in buildings (eg, apartment complexes) are at risk too. Sometimes whole buildings need to be evacuated over concerns of a carbon monoxide leak!

Carbon monoxide does a lot of things to your body, none of which seem pleasant. For example:
-Left shift of oxygen-hemoglobin dissociation curve causing less oxygen to be delivered to your organs
-Mitochondrial toxicity
-Cell death
-Heart and brain toxicity

Although there is controversy surrounding the treatment strategies for carbon monoxide toxicity, the BEST thing you can do is get away from the carbon monoxide. After that, focusing on modalities for management like oxygen (ie, hyperbaric oxygen) are going to be best.

If you have questions about how to take care of a patient exposed to carbon monoxide , please call your local poison control center and/or toxicologist! That is what we are here for!

Also, PLEASE make sure you have a carbon monoxide detector in your living area.

also one time our carbon monoxide detector went off in the middle of the night and I turned to my husband and was like BABE WAKE THE FUCK UP WE GOTTA GO I'VE BEEN PREPPING FOR THIS MY ENTIRE LIFE and it turns out the detector just had low battery so always change your batteries👍

Always keep carbon monoxide toxicity in the back of your head when treating patients with vague nonspecific symptoms, especially if those symptoms improve when they leave their home or if multiple people (or pets!) in the home are having symptoms.

Thanks all!

#ToxTweets

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More from @jtrebach

Josh Trebach, MD

@jtrebach

Nov 30, 2022

After taking tons of tests over the years, I have honed a study technique that works well for me.

And hopefully, it works for you too!

A thread on the study technique that got me through med school, residency, fellowship, and one of the hardest board exams I’ve ever taken:🧵📚

Step 1: Gather materials

This technique requires a white board (or a wall with paper on it), sticky notes, a pen, and your study material. Ideally, the white board would be in a place you are studying in each day such as your bedroom, office, or cubicle.

Step 2: Create categories

For me, the categories were either lectures (Lecture #1, Lecture #2, etc) or subjects (Endocrine, Hematology, etc). It doesn’t matter how many categories there are. I have had anywhere from 6 to 30 categories depending on the test. Put 'em on the board.

Read 13 tweets

Josh Trebach, MD

@jtrebach

Nov 28, 2022

A 18-year-old male presents to the emergency department with confusion and hallucinations for over 24 hours. He keeps muttering that he was "bitten by the dragonfly."

What do you think is going on?☠️☠️

Turns out it wasn't an actual dragonfly, but rather, the compound known as 1-(8-Bromobenzo[1,2-b;4,5-b]difuran-4-yl)-2-aminopropane!!!!!!

Because the structure of this compound kind of looks like a dragonfly and it has a bromine on it, it is also called Bromo-DragonFLY.🐉🪰

Bromo-DragonFLY was first synthesized in the lab in 1998. It was briefly looked into as a potential antidepressant. It works by being agonist at serotonin receptors (and this is likely what mediates the hallucinogenic effects). It can be a powder, liquid, or on blotter paper.