Andrew Stolbach, MD, MPH
@toxicologist12.bsky.social
Toxicologist. Emergency doctor. Living in Baltimore City.
Teaching and learning about poisoning and overdose.
Teaching and learning about poisoning and overdose.
Hospital pro tip:
Put a Chux pad on your seat and no one will steal it.
Put a Chux pad on your seat and no one will steal it.
August 6, 2025 at 1:14 AM
Hospital pro tip:
Put a Chux pad on your seat and no one will steal it.
Put a Chux pad on your seat and no one will steal it.
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?
Is there a single birth date that produced humans with a greater historical impact than February 12, 1809?
February 12, 2025 at 1:42 PM
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?
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.
February 6, 2025 at 6:48 PM
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.
Atropine will treat these findings, although it won't affect nicotinic symptoms such as skeletal muscle weakness.
2/4
2/4
January 3, 2025 at 9:52 PM
Atropine will treat these findings, although it won't affect nicotinic symptoms such as skeletal muscle weakness.
2/4
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
If you see some combination of "SLUDGE" and "KILLER B" symptoms, strongly consider the cholinergic toxidrome.
The main treatment is atropine.
1/4
January 3, 2025 at 9:52 PM
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
If you see some combination of "SLUDGE" and "KILLER B" symptoms, strongly consider the cholinergic toxidrome.
The main treatment is atropine.
1/4
For now, I’m keeping my Twitter account open, but I will be posting more over at the other place under the same name.
December 12, 2024 at 3:44 AM
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.
One of them grew up and became US President.
Two of them died from bovine tuberculosis from drinking *raw milk* from the family cow.
November 15, 2024 at 1:56 AM
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.
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 🤷🏻♂️
December 12, 2024 at 3:44 AM
This product is neither liquid nor given by IV route 🤷🏻♂️
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.
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.
December 12, 2024 at 3:44 AM
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.
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.
December 12, 2024 at 3:43 AM
Everyone who has ever worked in a hospital knows what the presence of this at the nursing station means.
December 12, 2024 at 3:43 AM
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!
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!
December 12, 2024 at 3:43 AM
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!
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/
The explanation is faster diazepam entry into the brain.
pubmed.ncbi.nlm.nih.gov/2746493/
December 12, 2024 at 3:43 AM
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/
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…
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…
December 12, 2024 at 3:43 AM
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…
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…
Me, when the med student says he didn’t order a urine tox because
“I remembered your lecture”
“I remembered your lecture”
December 12, 2024 at 3:43 AM
Me, when the med student says he didn’t order a urine tox because
“I remembered your lecture”
“I remembered your lecture”
Me, walking out of the room with tubes of CSF
December 12, 2024 at 3:42 AM
Me, walking out of the room with tubes of CSF
Reminder:
The suffix “-itis” refers to inflammation.
“Transaminitis” = Inflammation of your Trans Am.
The suffix “-itis” refers to inflammation.
“Transaminitis” = Inflammation of your Trans Am.
December 12, 2024 at 3:42 AM
Reminder:
The suffix “-itis” refers to inflammation.
“Transaminitis” = Inflammation of your Trans Am.
The suffix “-itis” refers to inflammation.
“Transaminitis” = Inflammation of your Trans Am.
We have also been seeing the new nitazene opioids at @HopkinsMedicine.
Patients have been responding to naloxone (narcan), so no need for a change in our treatment paradigm.
pubmed.ncbi.nlm.nih.gov/35708103/
Patients have been responding to naloxone (narcan), so no need for a change in our treatment paradigm.
pubmed.ncbi.nlm.nih.gov/35708103/
December 12, 2024 at 3:42 AM
We have also been seeing the new nitazene opioids at @HopkinsMedicine.
Patients have been responding to naloxone (narcan), so no need for a change in our treatment paradigm.
pubmed.ncbi.nlm.nih.gov/35708103/
Patients have been responding to naloxone (narcan), so no need for a change in our treatment paradigm.
pubmed.ncbi.nlm.nih.gov/35708103/
When this was laying out at the start of gym class you knew it would be a good day.
x.com/Whotfismick/st…
x.com/Whotfismick/st…
December 12, 2024 at 3:42 AM
When this was laying out at the start of gym class you knew it would be a good day.
x.com/Whotfismick/st…
x.com/Whotfismick/st…
As the homicide rate declines, people are still dying of overdose in Baltimore at a higher rate than any other big American city.
x.com/RyanLittleE/st…
x.com/RyanLittleE/st…
December 12, 2024 at 3:41 AM
As the homicide rate declines, people are still dying of overdose in Baltimore at a higher rate than any other big American city.
x.com/RyanLittleE/st…
x.com/RyanLittleE/st…
Harry Truman co-owned a clothing store when he was young. This man needs to be in any Best-Dressed President Top Five.
x.com/dieworkwear/st… gentlemansgazette.com/harry-s-truman…
x.com/dieworkwear/st… gentlemansgazette.com/harry-s-truman…
December 12, 2024 at 3:41 AM
Harry Truman co-owned a clothing store when he was young. This man needs to be in any Best-Dressed President Top Five.
x.com/dieworkwear/st… gentlemansgazette.com/harry-s-truman…
x.com/dieworkwear/st… gentlemansgazette.com/harry-s-truman…
I love when I am sleeping after a night shift and a problem takes care of itself.
December 12, 2024 at 3:41 AM
I love when I am sleeping after a night shift and a problem takes care of itself.
It was nice to see folks spontaneously collecting outside the hospital today to appreciate the eclipse. For a few minutes we were all reminded of things bigger than ourselves.
December 12, 2024 at 3:41 AM
It was nice to see folks spontaneously collecting outside the hospital today to appreciate the eclipse. For a few minutes we were all reminded of things bigger than ourselves.