Patients with retained bullet fragments are at risk for toxic lead levels and should probably be screened for the first year after ballistic injury.

We need to understand arguments for and against full legalization of cannabis for recreational purposes. This has not only public health implications but has direct impact on the ED, with increased volume, trauma, and burden of psychiatric illness.

Cannabis has some medical benefit, but there are some adverse health consequences worth reviewing as additional states consider legalization in the U.S.

In heroin users specifically, 5% needed either repeat naloxone or oxygen > 2 hours after initial naloxone reversal. Observation for 3 hours may be safer, especially for those with polysubstance abuse.

Purified black widow spider antivenin was more effective for pain control than placebo and not associated with any adverse drug effects.

A 250mg/kg, 12-hour N-acetylcysteine (NAC) protocol was as effective as the usual 300mg/kg, 20-hour protocol in patients at lower risk for hepatotoxicity.

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.

Alex Chen goes in depth with this toxicology myth-bust on the risk of exposure to fentanyl or fentanyl analogs to prehospital personnel.

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.

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).