MDE 8714: Introduction to Medical Toxicology

Drs. Tamas Peredy, Cynthia Lewis-Younger, and Fred Aleguas - Tampa

Dr. Matthew Cook - LVHN

Medical Toxicology is best described broadly as the field of medicine with expertise in the health effects caused by pharmaceuticals, occupational exposures and environmental agents. Toxicologists assist in the management of medication overdoses, addiction and withdrawal states, envenomations, hazardous materials exposures and workplace hazards. Toxicologists oversee the clinical operations of a Poison Center.

In Tampa - Students should report to One Davis Blvd, Suite 203 (Second Floor) at 9 am on the first weekday of their rotation. The rotation coordinator is Rachel Matthews, and she can be reached at (813) 844-7044. Dr. Peredy can be reached at tperedy@tgh.org or tperedy@health.usf.edu.

Objectives

1. Become familiar with fundamental concepts underpinning the clinical management of Toxicological patients. Participation in the diagnosis and treatment of selected acute and chronic exposures in adults and children is expected. Elements of competency include reliable history-taking, physical examination aimed at the detection of toxidromes, formulation of differential diagnoses, implementation of treatment, and development of safe disposition plans.
2. Understand the principles, methods and controversies related to limiting toxic exposures by decontamination including gastric lavage, activated charcoal administration, renal replacement therapy, ion trapping, and hyperbaric oxygen.
3. Review knowledge of basic kinetic principles of drug absorption, redistribution, metabolism, and elimination.
4. Study poisoning epidemiology specifically within populations ‘at risk’ such as toddlers, the elderly, pregnant or nursing women, migrants and immigrants.
5. Complete case studies from approximately 20 classes of drugs and poisons commonly encountered in clinical practice.  Emphasis will be placed on assessing severity and initiating timely, appropriate treatment.
6. Learn guiding principles of the management of acute intoxication in the Emergency Department.  Commonly abused drugs for specific socioeconomic groups will be reviewed. Withdrawal states will also be discussed.
7. Become familiar with selected antidotes, their uses, doses, side effects and limitations.
8. Develop awareness for important agents of toxinology (naturally occurring toxins). These include plants and animals toxins, especially focusing on native venomous arthropods, reptiles and marine creatures.
9. Understand diagnostic toxicology laboratory techniques, limitations and costs of both qualitative and quantitative analyses.
10. Observe the clinical operation of a Poison Center. Understand the public health role of the Poison Centers in gathering and disseminating data including protected health information (PHI).

Activities

1. A mandatory orientation is to be attended by the student in the first few days of the rotation.
2. Observation and participation in telephone consultations at the Florida Poison Information – Tampa is expected. Students will review cases referred for medical treatment and other cases of interest.
3. A series of standard cases accompanies independent reading assignments. Expect about 20-24 hours of small group discussion.
4. Attendance at a variety of teaching rounds and meetings will be required.
5. Participation in inpatient consultations is expected. Volumes of patients are variable month to month. Students should keep a record of all patients encountered.
6. Students will be expected to prepare two 10 minute presentations on a pre-approved topic of their choice to be shared with toxicology rotators and poison center staff. It should be of narrow scope and of sufficient quality to be included in the rotators teaching files for future students to use.
7. Guided tours of the toxicology laboratory and other field trips (e.g. Lowry Park Zoo) may be available.
8.  The opportunity to conduct clinical or laboratory research, construct toxicology teaching materials, or to write a review paper for publication is encouraged and is available by arrangement in advance of the rotation.

Evaluation

1. Case study preparation will be assessed during discussions with the medical toxicologist.
2. Attendance at conferences and assigned poison center shifts will be counted in the evaluation.
3. A written test is not administered at the end of the month.
4. For special arrangements involving research, writing or teaching, quality and completion of the project will contribute to the grade.
5. Input on professionalism and participation will be solicited from the Poison Center staff.