March 19, 2019

Chair‘s Corner

Greetings from the toxicology section! I hope this edition of the toxicology newsletter finds you well in your community and academic professional lives. Please enjoy the newsletter arranged and edited by Charlotte Goldfine who we thank for all of her time and effort.

I would like your feedback (please email regarding your personal experiences in your emergency medicine practice regarding the following issues:

  1. What is your current level of hospital support and resource provision regarding substance abuse referral? Do you refer all such requests to a psychiatric triage clinician/service in every instance or only when there is suspected need for dual-diagnosis? Does your hospital have a substance use consultation service that assists you with such efforts (and if so, is it in-patient or out-patient)? Or do you personally organize/arrange for such resources on your own?
  2. Do you employ a medication-algorithm for treatment of cyclical-vomiting-syndrome, and does your treatment include capsaicin topical cream (if so, what percentage cream)?
  3. Have you and all providers in your emergency departments completed buprenorphine training to start new prescriptions from the ED? And do you have any questions for ACEP that you would like addressed surrounding this training/issue?
  4. Do you use ketamine in sub-dissociative doses for analgesia regularly, and if not, why not? Have you found other roles and indications for ketamine in your emergency departments that the toxicology section members might benefit from hearing about (i.e. in alcohol withdrawal; delirium; psychosis/agitation)?

I realize that answering these questions may present a seemingly additional ‘to-do’ item to your already busy schedule. My goal is to share our divided (but common) experience(s) with the entire section in the next newsletter via collating responses and sharing their anonymous content so that we may better learn from each other’s knowledge base and comfort levels.


Chris Rosenbaum MD