I know someone else has chewed on this as long as me.

Help.

Rumack's oral NAC for acetaminophen planned 2.5 mmol NAC per hour

2.5= 1.5 mmol to cover natural glutathione (GSH) turn over per hour
+
1 mmol/hr to achieve 4 mmol in 4 h.
shorturl.at/LY0b0 4 mmol was selected because animals see hepatic necrosis from APAP when 70% glutathione (GSH) is depleted.

Bench data showed average liver was 4 mmol GSH/L and 1.5 L. So the average liver had 6mmol GSH (1.5L x 4L), and 4mmol was 70% of the GSH

shorturl.at/LY0b0

You're working in the ED when a 30 y.o male presents 30 minutes after envenomation to the right index finger by his pet snake (left).

He has a picture of culprit (right) , and it is definitely NOT from America.

A 🧵on U.S. exotic envenomation management.

(shared with consent)

This involved a Blue Indonesian pit viper (Trimereserus Insularis) but this could have been any exotic snake. There have been 50-110 exotic snake bites reported to Poison Centers annually since 2012.

P.S. limited free copies of report available here:
tandfonline.com/eprint/D6PYXIG…

Toxicologists are often consulted about 🍄foraging misadventures (wild mushroom ingestion).

Usually you don't get a clear mushroom image like this video (at best a blurry photo of some OTHER mushroom), or more often no image.

So what to do?

A 🍄🧵
#FOAMed #FoamCC #MedEd

https://twitter.com/EMPoisonPharmD/status/1671554759843512324

If you do have a good sample or photo you can work with a mycologist (your posion center knows one) to identify the shroom. But this is not frequent.

Had the opportunity to be part of a fascinating work. Americas Poison Center Annual report.

A comprehensive poisoning epidemiology study compiled of data from all 55 U.S. Poison Centers

Free 🔗➡️bit.ly/3wbIwWS
Pubmed🔗➡️bit.ly/3wdgeLP

A🧵on emerging trends This year we highlighted two important trends in addition to baseline poisoning data.

Firstly, THC product exposures have been increasing since 2016, and the demographics are changing. In 2021, edible products (red line) eclipsed plant based marijuana (blue line) for products

We wrote this case of #fentanyl exposure w/ NO clinical effects (bit.ly/3k7I1dF) to help realign fentanyl exposure risk perception.

I thought it was one of the only confirmed cases...turns out there are quite a few.

A 🧵on NIOSH health hazard evaluations
#MedEd If someone is concerned that hazards are interfering with their job function, NIOSH can get called in to do a field evaluation.

They review exposures, med records, forensics, and write public reports.

They have QUITE a few confirmed fentanyl reports.

cdc.gov/niosh/hhe/defa…

A few years ago I made a digital resuscitation game with a working cardiovascular system. A playground to play with pressors/resuscitation.

TODAY I REALIZED I COULD PLAY IT IN Virtual Reality

So I made a video. An 11 part 🧵for VR septic intubation!
#FOAMcc #FOAMed #MedEd

https://twitter.com/EMPoisonPharmD/status/1251976160835178502

Part 2/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd

Tomorrow is NYE, there will be partying, pills, and powders. Some leading to overdose.

I work in the ER NYE/NYD & expect a few "OD's" from said pills n powders. What exactly is in them?

A 🧵from Camden, a VERY human 28 y.o male, on the illicit drug supply

#MedED #FOAMed Cam was out with his friends celebrating NYE with some beverages when one of his friends offered him a tan powder. Cam was pretty hesitant at first but..