Introduction The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient.Case Report This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre-and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg. Discussion Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.
Accreditation Council for Graduate Medical Education (ACGME)-accredited emergency medicine programs have no formal requirements regarding training and education in medical toxicology. From review of previously published survey data less than two-thirds of emergency medicine residencies had formalized access to teaching with toxicologists. To evaluate capacity for toxicology education at ACGME-accredited emergency medicine residency programs, assessment of satisfaction in toxicology education and receptiveness to tele-education modalities. Secondarily to determine feasibility of a pilot web education toxicology program. A survey was conducted in 2015 to evaluate toxicology education capacity, satisfaction with current toxicology education, and technological capabilities of emergency medicine residencies (n ¼ 167). We reviewed websites of non-responding residency programs to determine access to toxicology education. A pilot web-conference-based toxicology education program followed with one residency. Of programs that completed the survey (n ¼ 35, 21%), 77% offered a toxicology rotation for trainees and 60% had an American Board of Medical Toxicology (ABMT)-certified Toxicologist on staff. Programs dissatisfied with toxicology education did not have a toxicology fellowship or an ABMT-certified toxicologist. Participants in the pilot educational program favorably rated the usefulness of the technology, effectiveness of the lecture, value of the subject, and educational value. Barriers exist to implementation of web education. Access to toxicology education through a clinical rotation or medical toxicologist is not consistently available among emergency medicine residency programs, which may indicate programs lacking a toxicologist have lower levels of satisfaction. Successful components of the pilot educational program could be disseminated, but further standardization is indicated.
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