Board Review: Methadone Intoxication

Originally Published: Modern Resident, Jun/Jul 2010

Original Author: Dana Kindermann, MD Georgetown-Washington Hospital Center Dept. of Emergency Medicine

Submitted by: Saadiyah Bilal, Publications Committee, Co-Chair 


Case history:
56 y/o male BIBA, found in apartment by roommate with altered mental status x 24h, found lying in feces. Patient (pt) with multiple substance abuse related admissions and ED visits. On arrival, pt slow to respond, confused, A&O x 2, denies pain, takes 150mg PO methadone daily, denies other med/drug use. Initial EKG: QTc - 500ms, bigeminy. Pt loaded with IV Mg, IV fluids; all initial labs normal and pt transferred to floor. Three hours later, pt develops Torsades de Pointes (TdP).

Board Review: The Pediatric Airway

Originally Published: Modern Resident, Jun/Jul 2010

Original Author: Karen Serrano, MD
University of Wisconsin Dept. of Emergency Medicine

Submitted by: Saadiyah Bilal, Publications Committee, Co-Chair
 
Managing the pediatric airway poses unique challenges for the emergency physician, requiring a good understanding of pediatric anatomy and familiarity with child-specific tools and approaches for emergency airway.
Children are more susceptible to airway obstruction than adults. One millimeter of edema in a small caliber pediatric airway (4mm diameter in a neonate) leads to dramatically increased airway resistance compared to the same amount of swelling in an adult (d=8mm) due to the effect of radius to the 4th power on rate of flow. The relatively large tongue of children can also collapse against the posterior pharynx, resulting in airway obstruction. Maneuvers such as the chin-lift or