Ari Filip

Toxicologist and ER Doctor. Medical Director, Arkansas Poison Center. Opinions are my own ≠ my employer’s. Not medical advice.

[Ari Filip @AriFilipMD]

@PulmCrit @AsherMendelson Yep — for good reason, bupropion is specifically named in ACMT’s position statement on brain death evaluation in the poisoned patient.

[Ari Filip @AriFilipMD]

@nickmmark Appreciate the responses — learn a lot from these.

[Ari Filip @AriFilipMD]

@nickmmark Again, I still use lorazepam to align with prevailing practice/guidelines (maybe we are afraid of large numbers). Have always questioned it. ROC makes sense if people will buy into having sugammadex available for that indication. Easier argument now that it’s cheaper…

[Ari Filip @AriFilipMD]

@nickmmark I prefer succ. in the ED. Boils down to these 2 groups:

Trauma/stroke: loss of neuromuscular exam/most reflexes, in ICH for 1h+
non-hyperthermic agitated patients: risk of prolonged undersedation (find the right RASS early w/ succ)

Do you modify based on patient/indication?

[Ari Filip @AriFilipMD]

@allisonoconn Snakebite antivenoms too (we suspect) as these are equine and ovine derived. Adverse drug reaction rates here in Arkansas as high as 30% to some antivenoms (orders of magnitude higher than elsewhere).

[Ari Filip @AriFilipMD]

@DavidJuurlink @drkeithsiau Thank you for showing love to my 'zole.

[Ari Filip @AriFilipMD]

@Kaminski4Dorian @IM_Crit_ Yes, no kidding! I also have to tell people that if they aren’t willing to concentrate past the standard insulin drip concentration of 1U/mL, don’t bother (stability studies show safe to 16U/mL). Otherwise pts will drown at 1-10U/kg/hr

[Ryan Feldman (empoisonpharmd.bsky.social) @EMPoisonPharmD]

HOW DOES METHOCARBAMOL WORK?!?!?!

NO BODY KNOWS AND WE JUST KEEP GIVING IT AND GIVING IT

[Erin @eeryan22]

All (most) octreotide doses for sulfonylurea poisoning are beautiful and valid but you don’t have to poke people with extra needles just because it was trendy in the 90s.

https://t.co/AbdNv7FbIR

[Ari Filip @AriFilipMD]

@willyhfrick getting some I-64 nostalgia, drove right by my former apartment complex on your left. Stay safe!

[Ari Filip @AriFilipMD]

@ThommyTox @MikeMullinsMD An RCT would be nice — there is probably enough clonidine (and other imidazoline) toxicity to study it at this point.

[Ari Filip @AriFilipMD]

@ThommyTox @MikeMullinsMD And while bradycardia, AMS, hypoTN aren’t well documented or good patient centered outcomes since they are transient and resolve with stimulation, they do often prompt unnecessary intervention,
so they do matter in this instance

[Ari Filip @AriFilipMD]

@ThommyTox “It’s like the sex panther of antidotes ‘works 60% of the time, every time’”
-@MikeMullinsMD
-Run Burgundy

[Ari Filip @AriFilipMD]

@ThommyTox Whoa — a rare disagreement from me here. I don’t think my experience has been as good as the Seger paper below, but I think high dose naloxone is worth the risk… especially in kids:

https://t.co/ijWbLaMNCO

Best I ever saw it work was tizanidine. Felt like a party trick.

[Ari Filip @AriFilipMD]

@IM_Crit_ I am a big fan of this!

https://t.co/6EPbhp0GzC

[Ari Filip @AriFilipMD]

@eeryan22 @ThommyTox I wonder what important core life memories facts like these are replacing

[Ari Filip @AriFilipMD]

@eeryan22 @ThommyTox I hate that I know this now