Andrew Stolbach, MD, MPH

Mount Sinai Receives $3.8 Million Grant to Study New Synthetic Drugs and Opioid Overdoses in Emergency Departments to Prevent Deaths

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Exciting news: Our team has been awarded a NIDA R01 grant to fund "Fentalog II", a continuation of our groundbreaking collaboration to detect novel fentanyl analogue overdoses in EDs across ten major hospitals over five years. #syntheticopioids
#Medsky 🧵
www.mountsinai.org/about/newsro...

Hospital pro tip:

Put a Chux pad on your seat and no one will steal it.

Mitochondrial DNA is just
Mom Genes

Consultant: Nothing is wrong with this patient.

Me: Should I discharge them?

Consultant: No, you should order all these tests.

Me: Why?

Consultant: To see if anything is wrong.

A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812 (Pulitzer Prize Winner) The Life of Martha Ballard, Based on Her Diary, 1785-1812 (Pulitzer Prize Winner)

FYI, here is the a link to purchase and read reviews of this Pulitzer winner bookshop.org/p/books/a-mi...

I'm reading "A Midwife's Tale," a memoir of a 27-year career of a midwife from 1785 on. In case you're wondering, here is her hierarchy of medical condition:

Comfortable
Easier
Much as she was yesterday
Revived
Dangerous
Poorly
Very Ill
Very ill indeed
Seemingly dangerously ill
Seemingly expiring

#MedToxTuesday #ToxVisualPearl "Not Very A-peel-ing"
Which chemical, commonly used in chemical peels, can cause severe, gray colored skin burns upon direct contact? Answer in the comments!
Acetone | Hydrogen peroxide | Phenol | Salicylic acid
@ziadkazzi.bsky.social @toxicologist12.bsky.social

#MedToxTuesday Our latest #Fentalog study report reveals that although numerous NPS detected, including #xylazine #bromazolam, and #nitazene analogues, #Fentanyl remains most prevalent nationally. Report>> bit.ly/4jjJ8jm
‪@maninialex.bsky.social @toxicologist12.bsky.social @ziadkazzi.bsky.social

The wellness industry wants to make money by selling products that make you feel better.

The pharmaceutical industry wants to make money by selling products that make you feel better.

Only one of these is required by law to prove that their products work.

Toxicologist Dr. Johns Downs summarizes our current understanding of PFOS risks #ACMT2025

We also see Takotsubo after stimulant (eg cocaine or amphetamine) poisoning

We're pleased to announce the release of the Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits, developed through a partnership of 10 medical & prof. societies, including ACMT. bit.ly/4iQ3UqT
@toxicologist12.bsky.social @ryanmarino.bsky.social

Under-eights should not drink slushies containing glycerol, say doctors Study of 21 hospitalisations shows the iced drinks can cause decreased consciousness and low blood sugar Children under eight should not drink slushies containing glycerol, paediatricians have warned. Public health advice on their safety may need…

Under-eights should not drink slushies containing glycerol, say doctors

🚨Findings from ACMT pivotal study published in JAMA Network Open underscores the vital role of medical toxicology physicians in improving outcomes for pediatric patients admitted to the PICU due to poisoning.
Read it now >>> bit.ly/ACMTJAMA
@toxicologist12.bsky.social @toxicacmt.bsky.social

Give naloxone (narcan) for *hypoventilation*

-not-

Give naloxone (narcan) for *opioids*

*********************+
Hypoventilation—>
Give naloxone
(If it works, the cause was probably an opioid)

🚨The early bird gets the savings! 🪱🐦Register for #ACMT2025 activities by NEXT Friday 2/21 to save - and book your stay at the conference hotel while rooms are still available! ➡️http://bit.ly/acmtmeeting⬅️
@ziadkazzi.bsky.social @toxicologist12.bsky.social @nephrotox.bsky.social

Abe Lincoln and Charles Darwin were both born on *this day* in 1809.

Is there a single birth date that produced humans with a greater historical impact than February 12, 1809?

I don’t know if this was intentional, but I love the juxtaposition of a big formulaic protocol with an anti-protocol editorial directly across the center spread of ACEP Now.

SIGN OUT
There is a new patient in Room 2 who has delusions of invisibility.
I haven’t seen him yet.

Me: I wonder what is the biggest organ in the human body?

Dermatologist: The skin!

Me:
Ok, sure, but what’s the biggest *real* organ?

Fluoride in water and lower IQ in children — unconvincing research A recent study suggests a potential link between fluoride in drinking water and lower IQ in children. However, the research has significant flaws, and no connection is found at the standard fluoride…

A new study on #fluoride in water and lower #IQ in children is unconvincing. Lots of bias, and there isn't a difference at levels of 0.7 mg/L which is found in the USA. RFK Jr will use this study to push his Make America Have Cavities Again.

ACMT Position Statement on Sterile Solution Shortage

NEW: ACMT Position Statement on Sterile Solution Shortage. Auths: Maryann Amirshahi, Erin Fox, @toxicologist12.bsky.social
>> READ: bit.ly/3DMVG3L <<

I saw a note with “dialyzed” misspelled as “diazzled” and I imagined “what if Snoop Dogg had been a nephrologist?”

An ever rarer sight: Snow at Hopkins.

Cool, no?

I can't emphasize the last point enough. In cholinergic toxicity, patients have a lot of reasons to be tachycardia (hypoxia, hypovolemia, distress...) Keep giving atropine until secretions dry up, and then start an atropine drip.

4/4

"Atropinisation"

Titrate atropine dose to cessation of SLUDGE
–Patients with mild symptoms may need 1 to 2 mg (IM autoinjector or IV)
–Double doses every 5 minutes
–Some adults have received over 1000 mg (!!) of atropine in 24 hours
–Tachycardia is NOT a contraindication to atropine

3/4

Atropine will treat these findings, although it won't affect nicotinic symptoms such as skeletal muscle weakness.
2/4

Cholinergic Toxicity Recognition and Treatment with Atropine

If you see some combination of "SLUDGE" and "KILLER B" symptoms, strongly consider the cholinergic toxidrome.

The main treatment is atropine.
1/4

👆jokes aren’t medical advice 🙂. People can overdose on methylxanthines, including caffeine. (But coffee is delicious)

Me:
Do you drink an excessive amount of caffeine?

Patient:
No.

Me:
Well, you should, because it’s awesome.