1/ 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.

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

🚨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?

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.

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?

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

Me: Do you drink an excessive amount of caffeine? Patient: No. Me: Well, you should, because it’s awesome.

Worth reading Roald Dahl’s account of the death of his daughter Olivia, age 7

It's a good day to post this one:

Thank you for the invitation to your “Ugly Sweater” party. I’m afraid I must decline, because, as a gentleman, I only own classic, sophisticated sweaters.

Fatal methanol poisoning in a group of travelers staying at lodging known for serving free spirits/liquor.

Sports commentator: You can’t measure heart Echocardiographer: Left ventricular ejection fraction is 60%

For now, I’m keeping my Twitter account open, but I will be posting more over at the other place under the same name.

These are the Nixon brothers, growing up in Yorba Linda, CA in the 1920s. One of them grew up and became US President. Two of them died from bovine tuberculosis from drinking *raw milk* from the family cow.

This product is neither liquid nor given by IV route 🤷🏻‍♂️

Traces of metals like lead can be detected in tampons. They are probably naturally incorporated into the materials- like cotton- used to make them. There is *no evidence* that people absorb an amount that would hurt their health. x.com/acmtmedtox/sta…

Patient: I keep having urges to set up a stall and sell crafts. Me: That is bazaar.

pubmed.ncbi.nlm.nih.gov/15784664/

Air samples taken from filters of workers in the fentanyl manufacture industry. The single highest level (12.965 ng/L) requires 200-400 minutes to produce a "therapeutic" 100 mcg fentanyl dose in the unprotected. Even in the fentanyl factory, you won't breathe it and pass out.

Everyone who has ever worked in a hospital knows what the presence of this at the nursing station means.

Worth pointing out that the only overdose patients in data used for nalmefene FDA approval came from the 1990s, before synthetic opioids were on the streets. x.com/DrugAlcReports…

Treatment of delirium tremens in 1939 (below) vs today 1. No 2. Yes, but not paraldehyde 3. Yes! 4. Food is good 5. Yes, let's not argue about LR vs NS 6. See 4 7. "force" seems strong, see 5 8. Out of nowhere, but Yes 9. Yes! 10. Yes!

You may have observed that diazepam (valium) works faster than ativan (lorazepam) after both are injected. The explanation is faster diazepam entry into the brain. pubmed.ncbi.nlm.nih.gov/2746493/

Cyproheptadine always seemed like an odd choice for serotonin syndrome because it's hard to give a PO drug to really sick patients. These authors gave it patients with mild/moderate illness and they did fine, but perhaps they would have done fine without it, too. 1/2 x.com/joshwangmd/sta…

Cool to see one our @JohnsHopkinsEM out in the world making an impact 👏👏👏 @ejbcalvello x.com/elliotthaut/st…

Me: Do you want to play any music while I sew up this cut? Patient: Actually, is it ok if we listen to my audiobook about the Battle of Stalingrad? Me: [High fives patient]

Me, when the med student says he didn’t order a urine tox because “I remembered your lecture”

For the youngest children, who tend to “grab everything, put everything in their mouth,” the dangers are…high, [Toxicologist Dr. Brian ] Schultz said. If even a “very small amount” touches a child’s hand, and they go on to touch their mouth, “that’s all it’s going to take.” x.com/RyanLittleE/st…

Sorry, I didn’t return your email. I’ve been busy hurtling through the universe. x.com/MAstronomers/s…

In patients with overdose reported as “heroin”, 88% had fentanyl or fentanyl analog in blood, while only 27% had evidence of heroin. Fentanyl is everywhere, patients have no idea what is in the drugs they are buying. x.com/ManiniAlex/sta…

Me, walking out of the room with tubes of CSF

Olympic Trampoline was on TV in the doctor lounge. Absolutely traumatizing for the orthopedists and pediatricians.