Tox Myths and Mistruths

On Saturday 11th June 2016, The Irish Intensive Care Society Annual Scientific Meeting in Dublin will incorporate a Toxicology Symposium, celebrating the 150th anniversary of the Irish National Poisons Information Center. The full programme is available here (pdf), and from the point-of-view of a tox-obsessed intensivist, it looks pretty exciting! The international line-up alone includes Donna Seger (USA), Bruno Mégarbane (France), Leon Gussow of The Poison Review fame (USA) and John Myburgh (Australia). In addition, I will be speaking about ‘Tox Myths and Mistruths’, and the resources for the talk are provided below.

Toxicological myths and mistruths

What we think we know about the management of critically ill poisoned and envenomed patients is haunted by dogma. Most of the things we do, we do because we think they might work, not because we know they will work.

Why is this the case? What can be done about it?

We will consider these questions as we delve into some of the myths and mistruths of critical care toxicology. We will find out whether glucagon antidotal therapy should be renamed ‘gluca-gone’, consider whether calcium in digoxin toxicity really ‘turns hearts to stone’, attempt to unravel the puzzle of liver transplantation for paracetamol toxicity and ride the rollercoaster of antivenom therapy for Australian snakebite envenoming. Finally, we will consider the wider implications in our search for truth in critical care.

References and additional resources:

  1. Nickson CP. Calcium, Digoxin Toxicity and ‘Stone Heart’ Theory. [updated and cited 30 April 2016]. Available from:
  2. Nickson CP. Does Antivenom Work? [updated and cited 30 April 2016]. Available from:
  3. Nickson CP. Dogma and Pseudoaxioms. [updated and cited 30 April 2016]. Available from:
  4. Nickson CP. Glucagon as an antidote. [updated and cited 30 April 2016]. Available from:
  5. Nickson CP. Liver transplantation for Paracetamol Toxicity. [updated and cited 30 April 2016]. Available from:

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LITFL Review 233

LITFL review

Welcome to the 233rd LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.

The Most Fair Dinkum Ripper Beauts of the Week

resizer Cliff Reid deploys bilingual brilliance and teaches us to speak Resuscitese–error proofing common directives in a crisis. [JS]

Richard Body discusses whether compassion is a patient’s right in this great talk from SMACC Chicago. [SO]

The Best of #FOAMed Emergency Medicine

  • CanadiEM has an excellent systematic approach to interpreting the ECG in a pacemaker patient and identifying issues. [AS]
  • AEM Rounds is an exciting new FOAM site created by my colleagues in the Emergency & Trauma Centre at the Alfred Hospital in Melbourne. Trainees will like this brief, high impact vodcasts on Pelvic Trauma Minireview. There is also a Spine Trauma Review, detailing the Alfred approach to spine trauma clearance–a controversial area! [CN]
  • Our own Anand Swaminathan does a Critical Appraisal of the ENCHANTED trial evaluating low dose vs standard dose tPA in acute ischemic stroke–as does Adrian Wong, writing for the Bottom Line. Points to anyone who can explain what non-non-inferior means. [SR/SO]
  • Another great review from the guys at FOAMcast, this time on the management of seizures. [SL]
  • A thought provoking post on Overconfidence in the ED by Chris Gray at St Emlyns. [SL]
  • First 10 in EM has a great review of the early management of massive GI bleeding in the ED. [AS]

The Best of #FOAMcc Critical Care

The Best of #FOAMed Resuscitation

The Best of #FOAMtox Toxicology

The Best of #FOAMus Ultrasound

The Best of #FOAMped Paediatrics

The Best of #FOAMim Internal Medicine

The Best of #FOANed Nursing

The Best of Medical Education and Social Media

News from the Fast Lane

Reference Sources and Reading List

Brought to you by:

Last update: May 30, 2016 @ 5:04 am

The post LITFL Review 233 appeared first on LITFL: Life in the Fast Lane Medical Blog.

Memorial Day, 2016

Happy Memorial Day, which, per US Memorial, is defined as

Memorial Day, originally called Decoration Day, is a day of remembrance for those who have died in our nation’s service.

You can’t thank them but you can thank their families, and remember their sacrifice.