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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 Emer...
Flumazenil administration in poisoned pediatric
patients.
Kreshak AA, et al. Pediatr Emerg Care 2012;28(5):448-50.
83 pts
...
Flumazenil use in benzodiazepine overdose in
the UK: a retrospective survey of NPIS data.
Veiraiah A, et al. Emerg Med J 2...
RISK
BENEFIT
+ Beta-Blockers
Citation Design Outcome Flaws
Mohamad 2008 Retrospective, observational
(n = 364) - Utox
Dattilo 2008 Retrospective cohort...
Citation Design Outcome Flaws
Mohamad 2008 Retrospective, observational
(n = 364) - Utox
Dattilo 2008 Retrospective cohort...
The effects of IV calcium in patients with
digoxin toxicity.
Levine M, et al. J Emerg Med 2011;40(1):41-6.
Calcium
5 death...
Tox Dogmalysis
Bryan D. Hayes
@PharmERToxGuy
bhayes@umem.org
Outline
 - Flumazenil use in benzo poisoning (http://www.ncbi.nlm.nih.gov/pubmed/21053379, http://www.ncbi.nlm.nih.gov/pu...
Objectives
 Given a patient with digoxin or cocaine toxicity, appraise the historical
controversies of using calcium or b...
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
Tox Dogmalysis - Bryan Hayes
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Tox Dogmalysis - Bryan Hayes

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Tox-Dogmalysis is a talk about evidence in Toxicology. It’s been said that 50% of what we learn is incorrect; we just don’t know which 50%.

As the complexity of medicine increases, it is of the utmost importance for clinicians to be skeptical of old data and new data alike. Many in the FOAM community have made huge strides in busting myths that have persisted over time. However, sometimes we may declare myths busted too prematurely based on incomplete or misunderstood data.

This talk will explore three topics in toxicology for which the perceived myths may actually be true, or at least not completely busted.

Published in: Health & Medicine
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Tox Dogmalysis - Bryan Hayes

  1. 1. Tox Dogmalysis Bryan D. Hayes @PharmERToxGuy
  2. 2. Acad Emerg Med 1997;19(4):935-6.
  3. 3. 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
  4. 4. Flumazenil administration in poisoned pediatric patients. Kreshak AA, et al. Pediatr Emerg Care 2012;28(5):448-50. 83 pts 0 seizures 0 deaths
  5. 5. 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
  6. 6. RISK BENEFIT
  7. 7. + Beta-Blockers
  8. 8. Citation Design Outcome Flaws Mohamad 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
  9. 9. Citation Design Outcome Flaws Mohamad 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
  10. 10. 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%)
  11. 11. Tox Dogmalysis Bryan D. Hayes @PharmERToxGuy bhayes@umem.org
  12. 12. 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/
  13. 13. Objectives  Given 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.

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