Medical Toxicologist/Emergency Physician/Addiction Medicine, PHX Med Tox PD, Ironman x3, Mediocre ultra runner. #FriedChickenAndSweetTea #NACdaddy

Phoenix, AZ
Joined July 2015
Annual Herping Trip with Cale Morris, including all our fellows and some lucky applicants @SteveCurryMD @MedToxFellowshp @ToxAndHound @PhoenixHerp
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MedTox Fellows: 44YOM in ED c/o OD of new med. HR 129 noted, then seizures, hypotension, no pulses. Post ROSC, on epi: ABG- 7.26/40/65/18; Na 141, K 4.5, Cl 109, CO2 18, AG 14, lactate 4.7 mM. Glu 168 mg/dL. ECG post-ROSC & stat drug screen. What single agent best fits?
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#truth Often times the rule not the exception
MedTox Fellows: Don't be discouraged when you don't recognize a toxidrome in a comatose patient. This is a typical urine drug screen at our center. It is the exception to ever find a single substance. Meth, ketamine, fentanyl and PCP.
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MedTox Fellows: Don't be discouraged when you don't recognize a toxidrome in a comatose patient. This is a typical urine drug screen at our center. It is the exception to ever find a single substance. Meth, ketamine, fentanyl and PCP.
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MedTox Fellows: Board review. Here is a photo from social media. The molecular action of the toxin contained in this animal is most similar to which one of the following? And how is the toxin delivered? A. saxitoxin B. ciguatoxin C. bungarotoxin D. batrachotoxin E. brevetoxin
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Currency Contamination II. It has been long recognized paper currency is contaminated with methamphetamine & cocaine. We recently just took 1 bill (gloves & forceps) from 8 physicians’ or students’ billfolds/ purses, washed bills with methanol, and screened for drugs by LC/qTOFF.
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Adding suzetrigine to MS library. MedTox Fellows, this analgesic Na channel blocker is highly specific for Nav 1.8, mainly found in peripheral neurons. How else is blockade different from other Na channel blockers?
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1/ I once heard that a fever in the ICU was a "fever of too many origins." Same can be said altered mental status/encephalopathy! We put together a comprehensive approach to these challenging patients for #SeminarsinNeurology A thread with our approach! pubmed.ncbi.nlm.nih.gov/3913…
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MedTox Fellows: 13 YOM ingested "sleeping pills" after fight with parents. Suprapubic tenderness, dry axillae. Pupils normal. What might he have taken? @ToxAndHound @ToxicSnowEM
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MedTox Fellows: 28YOM, coma, friend says only drug used is gabapentin. Tachy and mydriasis. Urine stat mTOF/LC/MS screen below. Many agents used, some of which only metabolites are found. Which taken drug activates M4 muscarinic receptors but antagonizes all other M receptors?
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Vets and Vets! Veterinary agents and Toxic exposures in US veterans at Western Tox Conference. @SteveCurryMD @MedToxFellowshp
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Dietary Supplements kicking off day 2 at the Western Tox conference @SteveCurryMD @MedToxFellowshp. Where are you @hspungenmd?!
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At the Western Tox Conference at UC-Davis. Dr. Levine reviewing ILE and the evidence behind it. @SteveCurryMD @MedToxFellowshp
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Great talk by Dr. Ben Hunter! #IUEM THE FEST
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MedTox Fellows. All of following can produce primary resp alkalosis/primary met acidosis, hypokalemia, hyperglycemia, hypophos, and ketosis EXCEPT: A. EtOH withdrawal with ketoacidosis B. salicylate C. isopropanol D. methamphetamine E. terbutaline @toxandhound @ToxicSnowEM
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MedTox Fellows: Board review challenge. Match each number with a letter so that each letter is used only once. Do the easy ones first and the rest will follow quickly. Feel free to leave comments/questions. Answers in a couple days. @ToxAndHound @ToxicSnowEM
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