Toxicology updates in emergency medicine

Emergency medicine (EM) pharmacists play an important role in managing a wide range of toxicities, including overdoses, illicit substance use, chemical exposures, and envenomations. Their specialized expertise in pharmacotherapy, resuscitation, and drug mechanisms equips them to assess toxins, predict overdose effects, and collaborate with toxicologists and poison centers to optimize patient care. However, the rapidly evolving field of toxicology presents ongoing challenges, such as staying current with new toxins, addressing antidote shortages, and adapting to shifting treatment paradigms.

This article offers a comprehensive review of key toxicology topics relevant to EM pharmacists, with an emphasis on topics where their expertise is not only essential but often sought out. It highlights recent guidelines impacting management of common overdoses, reviews available evidence for established antidotes such as intravenous lipid emulsion, N-acetylcysteine, fomepizole, and antivenin while providing a rationale for their evolving roles, and addresses toxicities associated with the ever-evolving landscape of illicit substances.

This article aims to equip readers with the knowledge and insights necessary to provide informed recommendations not just at the bedside through clinical management and education but also at the institution level through protocol development and formulary management.