Sunday, May 26, 2019 • 13:00 - 14:30
Track 5 - From Door to Morgue: Advanced Topics in Toxicology
Track Chair: Dr. Nancy Murphy
Room: 202

Considerations for Dialysis in the Poisoned Patient - Dr. Marc Ghannoum

Description: A systematic and comprehensive approach for techniques such as hemodialysis in the management of the poisoned patient. This assessment requires an understanding of pharmacokinetics, the poison’s characteristics, alternative therapies, available extracorporeal techniques, and clinical condition, all of which will be presented. Current EXTRIP guidelines will be presented.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Integrate extracorporeal modalities within a clinical framework.
  2. Determine what makes a poison “dialyzable”.
  3. Review EXTRIP recommendations.

Pearls

  1. Do a proper stepwise assessment: it only takes minutes.
  2. Call your nephrologist early on. Be convincing.
  3. The management of a poisoned patient does not start and certainly does not end with dialysis.

Dr. Marc Ghannoum is an internist and nephrologist from Verdun Hospital, affiliated to University of Montreal. He also holds a Masters in Pharmacology and Toxicology from the University of Florida. He currently is a FRQS research scholar. He is the founder and chair of the EXTRIP workgroup which focuses on international guidelines for the use of dialysis in the context of drug poisonings. He has over 70 peer-reviewed publications to his credit and over 10 book chapters.

Drug Intoxication Deaths in Nova Scotia - Dr. Matt Bowes

Description: Mortality statistics are often quoted by policy makers and politicians, but how are these statistics produced? What organizations are responsible for generating them, and how are their conclusions arrived at? In this lecture, Dr. Bowes will explore the epidemiology of intoxication deaths and how medical examiners investigate and classify them.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Describe the epidemiology of drug intoxication fatalities in Nova Scotia.
  2. Describe the process of medicolegal death investigation in Nova Scotia and review the role of the autopsy in the investigation of drug-related fatalities.
  3. Describe which deaths are reportable to the medical examiner.
  4. Describe in broad terms the differences between provinces in how medicolegal death investigation is organized.

Pearls

  1. We should not assume that intoxication mortality rates are comparable between provinces.
  2. Nova Scotia’s intoxication mortality rate has not changed in recent years, in contrast to some other provinces.
  3. Hydromorphone remains the most common agent found in acute intoxication deaths in Nova Scotia.

Dr. Matt Bowes is the Chief Medical Examiner for Nova Scotia and holds an academic appointment at Dalhousie University. He is a member of the Forensic Pathology Specialty Committee and the Forensic Pathology Board of Examiners of the Royal College of Physicians and Surgeons of Canada. He is a former Chair of the Forum of Chief Coroners and Chief Medical Examiners of Canada.

Organ Donation in the Poisoned Patient - Dr. Osama Loubani

Description: Severe brain injury can occur in poisoned patients either directly because of the poisoning, or due to a secondary cause such as trauma. In these cases, organ donation should be considered, whether or not the patient is brain dead.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Review criteria for organ donation in patients that are brain dead, and those that are not brain dead.
  2. Describe considerations specific to the poisoned patient when considering organ donation.

Pearls

  1. Organ donation is possible even in patients who are not brain dead. Donation after cardiac death can be used in patients with severe brain injuries who are not brain dead.
  2. Brain death often cannot be declared clinically in the acutely poisoned patient, ancillary are needed.
  3. Organ failure due to poisoning is sometimes reversible even in severe cases. Do not discount the potential to donate an organ just because it is injured.

I am an Emergency Physician with a fellowship in ICU. I split my time between the emergency department and intensive care in Halifax.