Episode Details

Ryan and Toxo cover some topics off the "one pill can kill" list, try breaking down the toxic mechanism of opioid induced respiratory depression in a simplistic way (but maybe fail), and walk through the triage and management of poison center case where a child was "potentially" exposed to a lethal toxin at home.

Case Report

• Pediatric ingestion case study discussed at the beginning of the episode: https://pediatrics.aappublications.org/content/130/6/e1700

"One Pill Can Kill" Resources

1. Missouri Poison Center resource guide:http://missouripoisoncenter.org/wp-content/uploads/2015/02/2011-One-Pill-Can-Kill.pdf
2. Pediatric poison prevention article:https://pubmed.ncbi.nlm.nih.gov/16419734/
3. HealthyChildren.org guide on medication safety:https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Poison-Prevention-One-Pill-Can-Kill.aspx

Respiratory Centers and Drug Effects

• Detailed overview of the impact of drugs on respiratory centers:
• https://www.ncbi.nlm.nih.gov/books/NBK482414

Buprenorphine Studies

Epidemiology

1. AAPCC Annual Report on poisoning trends:https://pubmed.ncbi.nlm.nih.gov/31752545/
2. Trends in pediatric opioid exposures:https://pubmed.ncbi.nlm.nih.gov/32178937/
3. Trends in ED visits for unsupervised medication exposures:https://pubmed.ncbi.nlm.nih.gov/26347435/

Exposure Studies

1. U.S. Poison Center data on buprenorphine: https://pubmed.ncbi.nlm.nih.gov/29941678/
2. Harvard Emergency Medicine group analysis: https://pubmed.ncbi.nlm.nih.gov/27756148/
3. Maryland Poison Center/RADARS data:https://pubmed.ncbi.nlm.nih.gov/18381506/
4. ICU exposures in children:https://pubmed.ncbi.nlm.nih.gov/20921918/

Triage Considerations for Pediatric Exposures

• Symptoms: What are the current symptoms and their severity?
• Causative Agent & Exposure Characteristics: What substance was ingested, and in what quantity? What’s the context of the exposure?
• History: Includes past medical history, patient weight, and the time elapsed since exposure.
• Onset: When are symptoms expected to appear?
• Labs: Perform toxin-specific assessments where applicable.
• Aggravating/Remitting Factors: What interventions have already been performed, and ho