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1. Massive Atropine Eye Drop Ingestion Treated with High-Dose Physostigmine to Avoid Intubation

Author

Stellpflug, Samuel J, Cole, Jon B, Isaacson, Brian A, Lintner, Christian P, and Bilden, Elisabeth F

Subjects
atropine, anticholinergic, antimuscarinic, physostigmine, intubation, Diagnosis, Emergency Medicine, Medicine, Therapeutics
Abstract

Case: A 34-year-old male presented after ingesting 150 mg of atropine. He had altered mental status, sinus tachycardia, dry mucosa, flushed skin, and hyperthermia. Sequential doses of physostigmine, totaling 14 mg, were successful in reversing antimuscarinic toxicity and prevented the need to perform airway control with endotracheal intubation. At completion of treatment, heart rate and mental status had improved, and intubation was never performed.Discussion: Atropine causes anticholinergic toxicity; physostigmine reverses this by inhibiting acetylcholinesterase. Atropine eye drop ingestions are rare. The 14 mg of physostigmine administered is much higher than typical dosing. It is likely the physostigmine prevented intubation. Atropine eye drops can be dangerous, and physostigmine should be considered in treatment. [West J Emerg Med. 2012;13(1):77–79.]

Published
2012

3. Contributors

Author

Aaron, Cynthia K., primary, Abbott, Jean T., additional, Abu-Laban, Riyad B., additional, Adams, Bruce D., additional, Adams, James G., additional, Adams, Stephen L., additional, Adirim, Terry A., additional, Alagappan, Kumar, additional, Amsterdam, James T., additional, Anderegg, Christine, additional, Anderson, Megan L., additional, Anglin, Deirdre, additional, Ankel, Felix, additional, Arora, Sanjay, additional, Aufderheide, Tom P., additional, Ban, Kevin M., additional, Baran, Emily, additional, Bardsley, Christina E. Hantsch, additional, Barkin, Adam Z., additional, Barnosky, Andrew R., additional, Barsan, William G., additional, Becker, Bruce M., additional, Bengiamin, Rimon N., additional, Berg, Marc D., additional, Berg, Robert A., additional, Berkowitz, Carol D., additional, Bernstein, Edward, additional, Bernstein, Judith, additional, Bessen, Howard A., additional, Bhatia, Kriti, additional, Bilden, Elisabeth F., additional, Birnbaumer, Diane M., additional, Biros, Michelle H., additional, Bitterman, Robert A., additional, Blackwell, Thomas H., additional, Blum, Frederick C., additional, Blumen, Ira J., additional, Bocock, Jennifer M., additional, Bolgiano, Edward B., additional, Bontempo, Laura J., additional, Brady, William J., additional, Braithwaite, Sabina, additional, Brown, Calvin A., additional, Brown, James E., additional, Brunette, Douglas D., additional, Budhram, Gavin R., additional, Bunney, E. Bradshaw, additional, Burbulys, David, additional, Burns, Michael J., additional, Byyny, Richard L., additional, Cahill, John D., additional, Calder, Kirsten K., additional, Cantor, Richard M., additional, Caplen, Stuart M., additional, Carlson, Andrea, additional, Chan, Theodore C., additional, Chen, Lei, additional, Choi, Stephen B., additional, Clark, Richard F., additional, Clement, Philip A., additional, Coates, Wendy C., additional, Collier, Robert E., additional, Collings, Jamie L., additional, Colucciello, Stephen A., additional, Colwell, Christopher B., additional, Conway, Edward E., additional, Cooke, Jeremy L., additional, Cooper, Mary Ann, additional, Cordle, Randolph J., additional, Craig, Sandy A., additional, Cranmer, Hilarie, additional, Crocco, Todd J., additional, Croskerry, Pat, additional, Cwinn, A. Adam, additional, Cydulka, Rita K., additional, Danzl, Daniel F., additional, Davitt, Ana M., additional, Daya, Mohamud, additional, Delaney, Kathleen A., additional, Delbridge, Theodore R., additional, Lorenzo, Robert A. De, additional, Derlet, Robert W., additional, Desai, Shoma, additional, Dolcourt, Bram A., additional, Duvivier, Evelyn H., additional, Easter, Joshua S., additional, Eckstein, Marc, additional, Eisenhauer, Mary, additional, Emery, Matt, additional, Falk, Jay L., additional, Feng, Sing-Yi, additional, Fernández-Frackelton, Madonna, additional, Fiechtl, James F., additional, Finnell, John T., additional, Fitch, Robert W., additional, Foran, Mark, additional, Gallagher, E. John, additional, Garber, Boris, additional, Gausche-Hill, Marianne, additional, Gebhart, Mark E., additional, Geiderman, Joel M., additional, Gibbs, Michael A., additional, Glass, Casey M., additional, Goldberg, Richard, additional, Gough, John E., additional, Graff, Louis, additional, Gray, Richard O., additional, Gross, Eric, additional, Guisto, John A., additional, Guss, David A., additional, Gussow, Leon, additional, Habal, Rania, additional, Haile-Mariam, Tenagne, additional, Hamilton, Glenn C., additional, Hargarten, Stephen W., additional, Harrigan, Richard A., additional, Heegaard, William G., additional, Heer, Jag S., additional, Heilpern, Katherine L., additional, Hemphill, Robin R., additional, Henderson, Sean O., additional, Hendrickson, Robert G., additional, Henneman, Philip L., additional, Hern, Jr., H. Gene, additional, Ho, Kendall, additional, Hockberger, Robert S., additional, Hoffman, Robert S., additional, Honigman, Benjamin, additional, Horeczko, Timothy, additional, Hostetler, Mark A., additional, Houry, Debra E., additional, Huff, J. Stephen, additional, Hung, Oliver, additional, Hutson, H. Range, additional, Inaba, Alson S., additional, Isenhour, Jennifer L., additional, Iserson, Kenneth V., additional, Jackimczyk, Kenneth, additional, Jagoda, Andy, additional, James, Thea L., additional, Janz, Timothy G., additional, Jones, Alan, additional, Jones, James B., additional, Jones, Jonathan S., additional, Jouriles, Nicholas J., additional, Kaji, Amy H., additional, Kalbfleisch, Norman, additional, Kao, Louise, additional, Katz, Dan, additional, Keadey, Matthew T., additional, Kercher, Eugene E., additional, Kiai, Kianusch, additional, King, Kelly E., additional, Kirelik, Susan, additional, Klein, Eileen J., additional, Kline, Jeffrey A., additional, Knaut, Andrew L., additional, Koenig, Kristi L., additional, Kontrick, Amy V., additional, Kornblau, Dina Halpern, additional, Kosowsky, Joshua M., additional, Kothari, Rashmi U., additional, Krauss, Baruch, additional, Kulig, Ken, additional, Kwiatkowski, Thomas, additional, Lavoie, Frank W., additional, Lavonas, Eric J., additional, Lee, Christopher C., additional, Lee, David C., additional, Lehrmann, Jill F., additional, Lerner, E. Brooke, additional, Levine, Michael D., additional, Lewis, Roger J., additional, Lin, Michelle, additional, Ling, Louis J., additional, Lipsky, Ari M., additional, Losman, Eve D., additional, Lowell, Mark J., additional, Lowery, Douglas W., additional, Ly, Binh T., additional, Lyn, Everett T., additional, Mahadevan, Malcolm, additional, Mahoney, Brian D., additional, Mailhot, Thomas, additional, Mallon, William K., additional, Maloney, Jr., Gerald E., additional, Mandavia, Diku P., additional, Manno, Mariann, additional, Marco, Catherine A., additional, Markovchick, Vincent, additional, Martel, Marc L., additional, Marx, John A., additional, Mayersak, Ryanne J., additional, Mazor, Suzan S., additional, McCollough, Maureen, additional, McKay, Mary Pat, additional, McKenzie, L. Kendall, additional, McKeown, Nathanael J., additional, McManus, John, additional, McMicken, David B., additional, McQuillen, Kemedy K., additional, Meislin, Harvey W., additional, Melio, Frantz R., additional, Meurer, William J., additional, Mick, Nathan W., additional, Miner, James R., additional, Mitchell, Connie, additional, Moore, Gregory P., additional, Moran, Gregory J., additional, Morrison, Laurie J., additional, Muelleman, Robert L., additional, Murray, Lindsay, additional, Murphy, Michael F., additional, Nadkarni, Vinay M., additional, Nakamura, Yoko, additional, Nelson, Lewis S., additional, Neumar, Robert W., additional, Newton, Edward J., additional, Newton, Kim, additional, Niemann, James T., additional, Nowak, Richard M., additional, O’Brien, John F., additional, Olshaker, Jonathan S., additional, Otten, Edward J., additional, Oyama, Leslie C., additional, Pallin, Daniel J., additional, Paris, Paul M., additional, Perina, Debra, additional, Perron, Andrew D., additional, Perry, Shawna J., additional, Peterson, Michael A., additional, Pfaff, James A., additional, Pfeil, Sharon, additional, Phillips, William James, additional, Platt, Melissa, additional, Polis, Michael Alan, additional, Pollack, Charles V., additional, Price, Timothy G., additional, Purcell, Thomas B., additional, Ramanujam, Prasanthi, additional, Rao, Rama B., additional, Raukar, Neha P., additional, Rhee, James W., additional, Richards, David B., additional, Richards, John R., additional, Roberts, David J., additional, Rodenberg, Howard, additional, Rodgers, Kevin G., additional, Rothman, Richard E., additional, Rubin, David H., additional, Rund, Douglas A., additional, Runyon, Michael S., additional, Russi, Christopher S., additional, Salhi, Bisan A., additional, Santen, Sally A., additional, Saveanu, Radu V., additional, Scarfone, Richard J., additional, Schmidt, Michael J., additional, Schneider, Diana C., additional, Schultz, Carl H., additional, Schwartz, Richard B., additional, Scott, Susan M., additional, Seger, Donna L., additional, Seiden, Jeffrey A., additional, Seirafi, Jennifer, additional, Sercombe, Clare T., additional, Sexton, Joseph D., additional, Shapiro, Marc J., additional, Shapiro, Nathan I., additional, Sharieff, Ghazala Q., additional, Sharma, Rahul, additional, Shearer, Peter, additional, Shih, Richard D., additional, Shoenberger, Jan M., additional, Shockley, Lee W., additional, Silbergleit, Robert, additional, Simon, Barry C., additional, Singer, Adam J., additional, Singer, Jonathan I., additional, Singh, Amardeep, additional, Slaughter, Laura, additional, Smith, Jeffrey Paul, additional, Smock, William Spafford, additional, Sokolove, Peter E., additional, Soroff, Harry S., additional, Squire, Benjamin, additional, Stettler, Brian A., additional, Stewart, Sara T., additional, Stocker, David M., additional, Stone, Susan, additional, Strote, Jared, additional, Swadron, Stuart P., additional, Tadros, Allison, additional, Taira, Breena R., additional, Talan, David A., additional, Tayal, Vivek S., additional, Thomas, Stephen H., additional, Tibbles, Carrie D., additional, Tobias, Joshua J., additional, Tokarski, Glenn F., additional, Tomaszewski, Christian, additional, Torbati, Sam S., additional, Torrey, Susan P., additional, Tran, T. Paul, additional, Ugras-Rey, Sandra, additional, Vakil, Monira, additional, Vary, Marshall G., additional, Velez, Larissa I., additional, Vicario, Salvator, additional, Vissers, Robert J., additional, Walls, Ron M., additional, Watson, Mark, additional, Wax, Paul M., additional, Wears, Robert L., additional, Weber, Ellen J., additional, West, Hugh H., additional, Wheatley, Matthew A., additional, White, Benjamin A., additional, White, Suzanne R., additional, Wiebe, Robert A., additional, Wightman, John M., additional, Williams, Saralyn R., additional, Winter, Adria O., additional, Wittler, Mary A., additional, Wolfe, Jeannette M., additional, Wolfson, Allan B., additional, H. Woolfrey, Karen G., additional, Woolfrey, Michael, additional, Wright, Joshua L., additional, Yang, Samuel, additional, Yaron, Michael, additional, Yealy, Donald M., additional, Young, Amy, additional, Young, Kelly D., additional, Younger, John G., additional, Zane, Richard, additional, Zich, David K., additional, Zimmer, Gary D., additional, Zink, Brian J., additional, Zull, David, additional, and Zun, Leslie S., additional

Published
2010
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6. Awareness of state legislation on naloxone accessibility associated with willingness to prescribe naloxone

Author

Okoro, Olihe N., Bastianelli, Karen M., Wen, Ya-Feng, Bilden, Elisabeth F., Konowalchuk, Brian K., and Schneiderhan, Mark E.

Abstract

ABSTRACTBackground: Increasing rates of opioid-related deaths, state naloxone legislation changes, and negativity prompted investigation of predictive factors associated with willingness to prescribe naloxone to populations at risk of overdose, including knowledge of risk factors, assessment of persons at risk, awareness of legislative changes, perceptions of professional responsibility, and confidence around naloxone prescribing and distribution. Methods: Cross-sectional, Web-based, anonymous, voluntary survey to prescribers of 2 regional health care systems serving urban and rural North Dakota, northern Minnesota, and northwestern Wisconsin. Human subject research was approved by university and health care systems' institutional review boards. Results: Overall, 203 of 1586 prescribers responded; however, not all prescribers completed each survey item. A majority (89.4%, n= 127/142) of respondents had never prescribed naloxone for overdose prevention. Willingness to prescribe naloxone for 4 patient care scenarios involving substantial opioid overdose risk ranged from 43.4% to 70.5%. Knowledge mean score was 15.5 (SD = 2.9) out of 22 with median 15 (range: 5–22). Naloxone legislation awareness score was 8.8 (SD = 3.8) out of 15 with median 8 (range: 3–15). There was a statistically significant but modest correlation between willingness to prescribe naloxone and the other variables, including awareness of state naloxone-related legislation (r= 0.43, P< .0001), level of self-confidence about dosing, prescribing, and writing protocols for naloxone (r= 0.37, P< .0001), general knowledge (r= 0.24, P= .0032), and perception of professional responsibility (r= 0.19, P= .03). Multivariate regression analysis indicated willingness to prescribe naloxone was associated with statistically significant predictors, including awareness of the naloxone laws (P= .0016) and self-confidence about dosing, prescribing, and writing protocols (P= .0011). Conclusions: Prescribers who are more aware of state laws regarding naloxone and confident in their knowledge of dosing, administration, and writing protocols may be more willing to prescribe naloxone.

Published
2018
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9. ENVENOMATIONS

Author

Walter, Frank G., primary, Bilden, Elisabeth F., additional, and Gibly, Raquel L., additional

Published
1999
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11. Contributors

Author

Aaron, Cynthia K., Abbott, Jean T., Abu-Laban, Riyad B., Adams, Bruce D., Adams, James G., Adams, Stephen L., Adirim, Terry A., Alagappan, Kumar, Amsterdam, James T., Anderegg, Christine, Anderson, Megan L., Anglin, Deirdre, Ankel, Felix, Arora, Sanjay, Aufderheide, Tom P., Ban, Kevin M., Baran, Emily, Bardsley, Christina E. Hantsch, Barkin, Adam Z., Barnosky, Andrew R., Barsan, William G., Becker, Bruce M., Bengiamin, Rimon N., Berg, Marc D., Berg, Robert A., Berkowitz, Carol D., Bernstein, Edward, Bernstein, Judith, Bessen, Howard A., Bhatia, Kriti, Bilden, Elisabeth F., Birnbaumer, Diane M., Biros, Michelle H., Bitterman, Robert A., Blackwell, Thomas H., Blum, Frederick C., Blumen, Ira J., Bocock, Jennifer M., Bolgiano, Edward B., Bontempo, Laura J., Brady, William J., Braithwaite, Sabina, Brown, Calvin A., III, Brown, James E., Brunette, Douglas D., Budhram, Gavin R., Bunney, E. Bradshaw, Burbulys, David, Burns, Michael J., Byyny, Richard L., Cahill, John D., Calder, Kirsten K., Cantor, Richard M., Caplen, Stuart M., Carlson, Andrea, Chan, Theodore C., Chen, Lei, Choi, Stephen B., Clark, Richard F., Clement, Philip A., Coates, Wendy C., Collier, Robert E., Collings, Jamie L., Colucciello, Stephen A., Colwell, Christopher B., Conway, Edward E., Jr., Cooke, Jeremy L., Cooper, Mary Ann, Cordle, Randolph J., Craig, Sandy A., Cranmer, Hilarie, Crocco, Todd J., Croskerry, Pat, Cwinn, A. Adam, Cydulka, Rita K., Danzl, Daniel F., Davitt, Ana M., Daya, Mohamud, Delaney, Kathleen A., Delbridge, Theodore R., Lorenzo, Robert A. De, Derlet, Robert W., Desai, Shoma, Dolcourt, Bram A., Duvivier, Evelyn H., Easter, Joshua S., Eckstein, Marc, Eisenhauer, Mary, Emery, Matt, Falk, Jay L., Feng, Sing-Yi, Fernández-Frackelton, Madonna, Fiechtl, James F., Finnell, John T., II, Fitch, Robert W., Foran, Mark, Gallagher, E. John, Garber, Boris, Gausche-Hill, Marianne, Gebhart, Mark E., Geiderman, Joel M., Gibbs, Michael A., Glass, Casey M., Goldberg, Richard, Gough, John E., Graff, Louis, IV, Gray, Richard O., Gross, Eric, Guisto, John A., Guss, David A., Gussow, Leon, Habal, Rania, Haile-Mariam, Tenagne, Hamilton, Glenn C., Hargarten, Stephen W., Harrigan, Richard A., Heegaard, William G., Heer, Jag S., Heilpern, Katherine L., Hemphill, Robin R., Henderson, Sean O., Hendrickson, Robert G., Henneman, Philip L., Hern, Jr., H. Gene, Ho, Kendall, Hockberger, Robert S., Hoffman, Robert S., Honigman, Benjamin, Horeczko, Timothy, Hostetler, Mark A., Houry, Debra E., Huff, J. Stephen, Hung, Oliver, Hutson, H. Range, Inaba, Alson S., Isenhour, Jennifer L., Iserson, Kenneth V., Jackimczyk, Kenneth, Jagoda, Andy, James, Thea L., Janz, Timothy G., Jones, Alan, Jones, James B., Jones, Jonathan S., Jouriles, Nicholas J., Kaji, Amy H., Kalbfleisch, Norman, Kao, Louise, Katz, Dan, Keadey, Matthew T., Kercher, Eugene E., Kiai, Kianusch, King, Kelly E., Kirelik, Susan, Klein, Eileen J., Kline, Jeffrey A., Knaut, Andrew L., Koenig, Kristi L., Kontrick, Amy V., Kornblau, Dina Halpern, Kosowsky, Joshua M., Kothari, Rashmi U., Krauss, Baruch, Kulig, Ken, Kwiatkowski, Thomas, Lavoie, Frank W., Lavonas, Eric J., Lee, Christopher C., Lee, David C., Lehrmann, Jill F., Lerner, E. Brooke, Levine, Michael D., Lewis, Roger J., Lin, Michelle, Ling, Louis J., Lipsky, Ari M., Losman, Eve D., Lowell, Mark J., Lowery, Douglas W., III, Ly, Binh T., Lyn, Everett T., Mahadevan, Malcolm, Mahoney, Brian D., Mailhot, Thomas, Mallon, William K., Maloney, Jr., Gerald E., Mandavia, Diku P., Manno, Mariann, Marco, Catherine A., Markovchick, Vincent, Martel, Marc L., Marx, John A., Mayersak, Ryanne J., Mazor, Suzan S., McCollough, Maureen, McKay, Mary Pat, McKenzie, L. Kendall, McKeown, Nathanael J., McManus, John, McMicken, David B., McQuillen, Kemedy K., Meislin, Harvey W., Melio, Frantz R., Meurer, William J., Mick, Nathan W., Miner, James R., Mitchell, Connie, Moore, Gregory P., Moran, Gregory J., Morrison, Laurie J., Muelleman, Robert L., Murray, Lindsay, Murphy, Michael F., Nadkarni, Vinay M., Nakamura, Yoko, Nelson, Lewis S., Neumar, Robert W., Newton, Edward J., Newton, Kim, Niemann, James T., Nowak, Richard M., O’Brien, John F., Olshaker, Jonathan S., Otten, Edward J., Oyama, Leslie C., Pallin, Daniel J., Paris, Paul M., Perina, Debra, Perron, Andrew D., Perry, Shawna J., Peterson, Michael A., Pfaff, James A., Pfeil, Sharon, Phillips, William James, Platt, Melissa, Polis, Michael Alan, Pollack, Charles V., Price, Timothy G., Purcell, Thomas B., Ramanujam, Prasanthi, Rao, Rama B., Raukar, Neha P., Rhee, James W., Richards, David B., Richards, John R., Roberts, David J., Rodenberg, Howard, Rodgers, Kevin G., Rothman, Richard E., Rubin, David H., Rund, Douglas A., Runyon, Michael S., Russi, Christopher S., Salhi, Bisan A., Santen, Sally A., Saveanu, Radu V., Scarfone, Richard J., Schmidt, Michael J., Schneider, Diana C., Schultz, Carl H., Schwartz, Richard B., Scott, Susan M., Seger, Donna L., Seiden, Jeffrey A., Seirafi, Jennifer, Sercombe, Clare T., Sexton, Joseph D., Shapiro, Marc J., Shapiro, Nathan I., Sharieff, Ghazala Q., Sharma, Rahul, Shearer, Peter, Shih, Richard D., Shoenberger, Jan M., Shockley, Lee W., Silbergleit, Robert, Simon, Barry C., Singer, Adam J., Singer, Jonathan I., Singh, Amardeep, Slaughter, Laura, Smith, Jeffrey Paul, Smock, William Spafford, Sokolove, Peter E., Soroff, Harry S., Squire, Benjamin, Stettler, Brian A., Stewart, Sara T., Stocker, David M., Stone, Susan, Strote, Jared, Swadron, Stuart P., Tadros, Allison, Taira, Breena R., Talan, David A., Tayal, Vivek S., Thomas, Stephen H., Tibbles, Carrie D., Tobias, Joshua J., Tokarski, Glenn F., Tomaszewski, Christian, Torbati, Sam S., Torrey, Susan P., Tran, T. Paul, Ugras-Rey, Sandra, Vakil, Monira, Vary, Marshall G., Velez, Larissa I., Vicario, Salvator, Vissers, Robert J., Walls, Ron M., Watson, Mark, Wax, Paul M., Wears, Robert L., Weber, Ellen J., West, Hugh H., Wheatley, Matthew A., White, Benjamin A., White, Suzanne R., Wiebe, Robert A., Wightman, John M., Williams, Saralyn R., Winter, Adria O., Wittler, Mary A., Wolfe, Jeannette M., Wolfson, Allan B., H. Woolfrey, Karen G., Woolfrey, Michael, Wright, Joshua L., Yang, Samuel, Yaron, Michael, Yealy, Donald M., Young, Amy, Young, Kelly D., Younger, John G., Zane, Richard, Zich, David K., Zimmer, Gary D., Zink, Brian J., Zull, David, and Zun, Leslie S.

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