Nerve Agent Incidents and Public Health Preparedness

Nerve Agent Incidents and Public Health Preparedness

Management of nerve agent (NA) poisoning requires recognition of the syndrome and availability of the antidote. It is important to remember that besides the classic “SLUDGE” and “Killer B’s,” there is also the nicotinic syndrome which can cloud the clinical presentation. Add the “weekdays” mnemonic for nicotinic effects to your list of symptoms in NA toxicity.

HOUR - Early Discharge After Opioid OD

HOUR - Early Discharge After Opioid OD

The HOUR clinical decision rule can help determine which patients with opioid overdose who have received prehospital naloxone are safe for discharge after one hour of observation. But clinician judgment was just as good, which begs the question of why we need a decision rule.

Predicting Severe Alcohol Withdrawal

Predicting Severe Alcohol Withdrawal

Individual risk factors associated with the development of severe alcohol withdrawal syndrome (SAWS) included a history of delirium tremens and baseline BP ≥ 140mmHg but no individual symptoms or signs associated with exclusion of SAWS. Composite measures fared better, such as the Prediction of Alcohol Withdrawal Severity Scale; a score ≥ 4 had a LR of 174 (95% CI 43-696).

Scheduled or PRN Crofab for Rattlesnake Bites?

Scheduled or PRN Crofab for Rattlesnake Bites?

PRN dosing of antivenom (Crofab) for rattlesnake bite based on a clinical and laboratory-triggered strategy led to an overall decreased hospital length of stay (LOS) (27h vs 34h) and amount of antivenom used (8 vs 16 vials) compared to standard maintenance dosing.

Coagulopathy From Contaminated Synthetic Cannabinoids

Coagulopathy From Contaminated Synthetic Cannabinoids

Think of synthetic cannabinoid use in patients with unexplained serious coagulopathy due to possible contamination with long acting vitamin K antagonists. They will need prolonged oral vitamin K treatment, which can challenging due to the cost.

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