Toxicology Elective

Medical toxicology is a clinical specialty that includes the monitoring, prevention, evaluation and treatment of injury and illness due to occupational and environmental exposures, pharmaceutical agents, as well as unintentional and intentional poisoning in all age groups.

Goals

Goals

The goals and objectives of the medical toxicology elective are to:

  • Provide a well-rounded experience in medical toxicology. This will be accomplished by providing the opportunity for bedside clinical evaluation, poison center consultation, outpatient consultation, and daily educational lectures.
  • Have medical students learn the application of basic sciences, especially pharmacology, in the recognition and management of various toxidromes.
  • Provide the rotator with an opportunity to teach medical toxicology to residents and students from other services by discussing consultant recommendations and presenting a lecture at the end of the monthly rotation.
  • Demonstrate the ability to critically review toxicology literature. The medical toxicology rotation includes a weekly journal club. The rotator will be expected to present and critique articles on toxicology issues.
  • Demonstrate proficiency at performing literature searches. The rotator will frequently be assigned medical toxicology questions/issues and will be expected to search the literature to come up with answers to the problem.
  • Demonstrate proficiency with electronic information databases that can be essential to the solution of toxicologic problems. The rotator will be introduced to the poisondex database and will utilize the poison center's electronic medical record during their rotation.
  • The student will develop effective communication skills, telephone history taking, and accurate transmission of information.
  • The rotation will allow students to acquire an understanding of toxic hazards of daily life and the practice of medicine

Curriculum

Duties

  1. Be present during daily rounds, lectures, clinic and journal clubs.
  2. Perform phone call follow-ups on in-house cases (not seen at bedside) and also 5 outside cases per day.
  3. Take at least 4 days of call (Monday through Friday) during the rotation. (Apply to residents only)
  4. Evaluate at least 1 clinic patient and help prepare a report under the supervision of the toxicology fellow assigned to the patient.
  5. Present at least 1 article during Tuesday Journal Clubs for the month.
  6. Prepare and present a 20-minute PowerPoint™ presentation on a detailed toxicology topic of your choice (towards the end of the rotation).
  7. Complete all self-learn case studies by the end of rotation.

Daily Routine (except for Tuesdays and Wednesdays)

  1. Weekdays other than Tuesdays or Wednesdays.
  2. Present to Poison Center at 8:00 am.
  3. Obtain a list of in-house patients by asking the charge SPI.
  4. Print out the case(s), obtain laboratory results, and do some preliminary reading about each topic.
  5. Round with fellow and attending (time will be announced by attending or fellow usually the day before).
  6. During Rounds you are expected to see the patient and participate in writing the History & Physical portion of the consult sheet.
  7. After rounds come back to poison center and document the case under POISON CALL TRACKING SYSTEM.
  8. Attend the clerkship teaching lectures and toxicology conference.
  9. Pick at least 5 active cases from POISON CALL TRACKING SYSTEM (can be patients from our hospital systems or other parts of Georgia) and perform follow-up and discussion. Do not offer any recommendations until you discuss those cases with the fellows or an attending.
  10. Conduct bedside consults at Grady Hospital until 3:00 pm daily.

Tuesday routine

  1. Attend Emergency Medicine Resident conference (8:00am - 1:00 PM).
  2. Attend Tuesday afternoon sessions, which start immediately after morning conference at the Georgia Poison Center.
  3. Conferences usually sessions include lecture(s), case discussions and/or journal club. Students are expected to be prepared for conferences by asking the presenting fellow or attending at least 1-day prior.

Wednesdays

  1. Rounds are to be completed before 9 AM.
  2. Toxicology Clinic runs from 09:00 - 12:00 PM.
  3. Students are expected to see patients alongside the Toxicology fellows.
  4. Students are expected to help prepare a written report of the case with the fellow.
  5. After clinic, students resume daily schedule as outlined above.

Thursdays

Case Conference.  Students present at least two cases on Thursday conference.  The cases can be cases that student sees on rounds or cases in which the student conducted a phone follow-ups (cases from outside hospitals).

Core Topics (lectures)

  1. General Approach to the Poisoned/Toxicologic patient toxidromes, withdrawal syndromes, basic antidotes, GI decontamination (1st day of rotation)
  2. Analgesics (APAP, ASA, NSAIDs)
  3. Cardiac drugs (CCB, BB, and Dig)
  4. Alcohols (Ethanol, ethylene glycol, methanol, isopropyl alcohol)
  5. Antipsychotics including NMS and SS
  6. Lithium, TCAs and a brief discussion on other antidepressants
  7. Drugs of Abuse including cocaine and hallucinogens
  8. Hypoglycemics

Required Self-Learn case studies from Agency for Toxic Substances & Disease Registry (ATSDR)

  1. Cholinesterase Inhibitors Including Insecticides and Chemical Warfare Nerve Agents case study. 
  2. http://www.atsdr.cdc.gov/csem/cholinesterase/cover_page.html
  3. Nitrate/Nitrite Toxicity (methemoglobinemia)
  4. http://www.atsdr.cdc.gov/csem/nitrate/no3physiologic_effects.html#objective
  5. Arsenic  http://www.atsdr.cdc.gov/csem/arsenic/index.html
  6. Lead  http://www.atsdr.cdc.gov/csem/lead/pbcover_page2.html

Reading Materials (A CD will be provided on the first day of rotation)

  1. Anesthetics
  2. Anticoagulants
  3. Anticonvulsants
  4. Antiparkinsonism drugs
  5. Bronchodilators
  6. Hazadrous materials/inhaled toxins (phosgene, chlorine, ammonia, cyanide, carbon monoxide, hydrogen sulfide)
  7. Hormones/Steroids
  8. Isoniazid
  9. Marine Toxins
  10. Sedatives/Hypnotics
  11. Strychnine
  12. Antihypertensives
  13. Hydrocarbons
  14. ED management of radiation injuries
  15. Mushrooms/Poisonous plants
  16. Snake Envenomations
  17. Caustics

Contact Us

Alaina Steck,MD
Clerkship Director, Toxicology
80 Jesse Hill Dr
Atlanta, GA 30303
asteck@emory.edu
Phone: 404.616.4403


Vanessa Walker
Clerkship Coordinator
80 Jesse Hill Drive
Atlanta, GA 30303
vwalker@georgiapoisoncenter.org
Phone: 404.616.4403