Toxicology

EDUCATIONAL GOALS AND OBJECTIVES

The educational objectives for the Emergency Medicine resident while on the Toxicology rotation are as follows:

Patient Care

  • Demonstrate the ability to obtain an appropriate history and physical exam for patients with toxicologic manifestations.
  • Demonstrate the ability to perform gastric lavage, whole bowel irrigation, skin and eye decontamination, and administration of activate charcoal.
  • Demonstrate clinical recognition of toxidromes associated with drug overdose and drug withdrawal.
  • Demonstrate the ability to recognize common venomous animals and poisonous plants and their clinical presentations and treatments.
  • Demonstrate knowledge of the diagnostic laboratory including methods, limits, and costs.
  • Demonstrate the proper technique for the handling of a HAZMAT contaminated patient in the ED and in the pre-hospital environment.
  • Demonstrate knowledge and skill necessary to manage a patient poisoned by any of the following: acetaminophen, amphetamines, anticholinergics, aspirin, barbiturates, benzodiazepines, beta blockers, calcium channel blockers, carbon monoxide, caustics, cocaine, cyanide, cyclic antidepressants, digitalis, ethanol, ethylene glycol, INH, iron, lithium, methanol, opiates, organophosphates, phenytoin, theophylline, and venomous animals.

Medical Knowledge

  • Discuss the basic principles of drug absorption, redistribution, metabolism, and elimination.
  • Discuss the indications, contraindications, dosages, and side effects of the currently available antidotes and antivenins.
  • Discuss the principle of hemodialysis and hemoperfusion and the toxic agents that can be removed by the methods.
  • Discuss the issues related to drug interactions, side effects, and therapeutic levels of the commonly used therapeutic agents.
  • Demonstrate knowledge of the common household poisons, pesticides, hydrocarbons, and metals, their effects and treatment.

Practice Based Learning and Improvement

  • Demonstrate ability to obtain and appraise medical literature applicable to toxciology.

Interpersonal and Communication Skills

  • Create and sustain a therapeutic and ethically sound relationship with patients.
  • Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills.
  • Work effectively with others as a member or leader of a health care team.

Professionalism

  • Demonstrate respect, compassion, and integrity.
  • Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.
  • Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities.

Systems-Based Practice

  • Understand how toxicologic care affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their practice of Emergency Medicine

The Emergency Medicine resident will accomplish these objectives in the following manner:

  • Attend and participate in daily Toxicology teaching rounds
  • Attend all conferences given by the NYC Poison Control Center while on rotation.
  • Evaluate and provide management recommendations for patients under the supervision of the Poison Center faculty and fellows.
  • Discuss and interpret results of all ancillary testing with supervisory faculty.

 

ROTATION INFORMATIOn

Where: NYC Poison Control Center. 455 First Avenue, Rm 124. New York, NY 10016. Tel: (212) 764-7667.

When: Mon – Fri 9:00 AM – 4:00 PM. Be on time!

Supervisors: Lewis S. Nelson, MD - Director, Fellowship in Medical Toxicology NYC PCC. 455 First Avenue, Room 123. New York, N.Y. 10016 Phone (212) 447-8150. Email: nycpcc@yahoo.com

Attire: business casual, except for 1st and last day when you need business attire (pants/skirt, shirt/blouse, tie, shoes).

Preparation: Review the Toxicology section of Tintinalli or Rosen’s. If you have the time, read Goldfrank’s Toxicology textbook (e-copy available).

Expectations: You will be expected to prepare and present a brief discussion of a medical toxicology-related subject of individual interest. In the morning you will participate in callbacks (calling back hospitals/institutions that called with a poison question/ consultation). From 1PM to 4PM, you will attend lectures/faculty rounds.