TOXICOLOGY


  

OBJECTIVES

1.     To become familiar with the initial approach to all patients with poisoning and overdose (Medical knowledge, patient care).

2.     To understand the indications and contraindications of gastric decontamination.

3.     To become familiar with the different types of metabolism kinetics and elimination of various drugs and poisons (Medical knowledge).

4.     To become familiar with the antidotes currently available (Medical knowledge).

5.     To become familiar with the initial management of common poisonings and overdoses including acetaminophen, aspirin, tricyclic antidepressants, lithium, digoxin, calcium channel blockers, beta-blockers, anticonvulsants, CO, methemoglobinemia, alcohols, iron, isoniazid, cyanide, organophosphates, antihistamines, anticholinergics, HFl acid, acid and alkali ingestions, and the stings of spiders and snakes (Medical knowledge, practice-based learning and improvement, patient care).

6.     To understand how a poison center works and how the center interacts with patients and physicians over the phone (Communication skills, system-based practice, practice-based learning).

 

DESCRIPTION OF CLINICAL EXPERIENCE

·         Each resident will take first call under the auspices of the Toxicology attending 5 days per week, with at least 2 weekends off. They will be primary consultants to the ED and MICU for acute poisonings and overdoses. They will round on inpatients with the Toxicology service. They will also spend time answering the phone in the Poison Center and seeing patients in the Toxicology clinic.

 

DESCRIPTION OF DIDACTIC EXPERIENCE

·         They will meet Monday - Friday with the Toxicology Attending and have directed reading assignments. In addition they will be responsible for presenting toxicology cases weekly at the Case Conference and a monthly lecture on a Toxicology topic at a didactic session.

 

EVALUATION PROCESS

·         The residents will receive written feedback from the faculty in the Division of Toxicology.

 

FEEDBACK MECHANISM

·         Residents will receive written feedback on the EM evaluation form and immediate clinical feedback from faculty.

 

This rotation is under the auspices of the Director of the Division of Toxicology and Director of the Poison Control Center. Residents are given copies of all rotation summaries at the beginning of their PGY-1 year. Residents should use rotation summaries, formatted written evaluations, and their performance on the In-service Examination to assess the rotation’s effectiveness.