Tox Dogmalysis - Bryan Hayes

Tox Dogmalysis

Bryan D. Hayes@PharmERToxGuy

Acad Emerg Med 1997;19(4):935-6.

A poison center’s ten-year experience with flumazenil administration to acutely poisoned

adults.

Kreshak AA, et al. J Emerg Med 2012;43(4):677-82.

904 pts

13 seizures

1 death

Flumazenil administration in poisoned pediatric patients.

Kreshak AA, et al. Pediatr Emerg Care 2012;28(5):448-50.

83 pts

0 seizures

0 deaths

Flumazenil use in benzodiazepine overdose in the UK: a retrospective survey of NPIS data.

Veiraiah A, et al. Emerg Med J 2012;29(7):565-9.

80 pts

1 seizure

0 deaths

RISK

BENEFIT

+ Beta-Blockers

Citation Design Outcome FlawsMohamad 2008 Retrospective, observational

(n = 364) - Utox

Dattilo 2008 Retrospective cohort (n = 363) + Utox

Hoskins 2010 Prospective, open label (n = 90) =

Rangel 2010 Retrospective cohort (n = 331) = Utox

Ibrahim 2013 Retrospective cohort (n = 387) = Utox

Fanari 2014 Retrospective cohort (n = 376) = Utox

Gupta 2014 Retrospective cohort, registry (n = 924) = Utox

Citation Design Outcome FlawsMohamad 2008 Retrospective, observational

(n = 364) - Utox

Dattilo 2008 Retrospective cohort (n = 363) + Utox

Hoskins 2010 Prospective, open label (n = 90) =

Rangel 2010 Retrospective cohort (n = 331) = Utox

Ibrahim 2013 Retrospective cohort (n = 387) = Utox

Fanari 2014 Retrospective cohort (n = 376) = Utox

Gupta 2014 Retrospective cohort, registry (n = 924) = Utox

The effects of IV calcium in patients with digoxin toxicity.

Levine M, et al. J Emerg Med 2011;40(1):41-6.

Calcium

5 deaths (22%)

0 dysrhythmias

No calcium

27 deaths (20%)

Tox Dogmalysis

Bryan D. Hayes@PharmERToxGuybhayes@umem.org

Outline - Flumazenil use in benzo poisoning (http://www.ncbi.nlm.nih.gov/pubmed/21053379,

http://www.ncbi.nlm.nih.gov/pubmed/22531190, http://www.ncbi.nlm.nih.gov/pubmed/21785147) 15920864 8644960 15214628 1286503 & 1611650 http://empharmd.blogspot.com/2013/11/flumazenil-friend-or-foe.html 8605789 22766408 http://www.thepoisonreview.com/2012/07/26/flumazenil-induced-seizures/ http://www.thepoisonreview.com/2012/05/08/is-use-of-flumazenil-in-poisoned-pediatric-patients-safe/

- Beta blockers in cocaine chest pain (Rangel C, et al. Arch Intern Med 2010;170:874-9) (Mohamad T, et al. Am J Ther 2008;15:531-5) (Dattilo PB, et al. Ann Emerg Med 2008;51:117-25) 23122421 + http://www.emlitofnote.com/2012/11/dont-blockade-cocaine-chest-pain.html

- Calcium use in digoxin poisoning (http://www.ncbi.nlm.nih.gov/pubmed/19201134, http://www.ncbi.nlm.nih.gov/pubmed/15461240) Bower JO. JAMA 1936;106-1151-3 Kne T. J Toxicol Clin Toxicol 1997;5:505 (abstract) http://www.thepoisonreview.com/2011/01/29/heart-of-stone-calcium-and-digoxin-toxicity/ http://lifeinthefastlane.com/education/ccc/calcium-digoxin-toxicity-and-stone-heart-theory/

ObjectivesGiven a patient with digoxin or cocaine toxicity,

appraise the historical controversies of using calcium or beta blockers, respectively, in these settings.

In a patient with benzodiazepine poisoning, determine when it is appropriate to administer flumazenil.