1 A medical subspecialty focused on the diagnosis, management and prevention of adverse health effects from medications, occupational & environmental toxins, and biological agents Medical Toxicology! SOLVENTS! PESTICIDES! HEAVY METALS! TERRORISM (Bio/Chem/Rad)! WORKER SAFETY & ENVENOMATIONS! FITNESS FOR DUTY! DRUG OVERDOSE! ACUTE ORGAN FAILURE SYNDROMES! BACK PAIN! REPETITIVE STRAIN INJURIES! Occupational Medicine! 2 Infectious Disease! Acute and Critical Care Medicine 2 3 Officially recognized as a subspecialty by the American Board of Medical Specialties Of ~800,000 physicians in the USA, less than 700 ever board certified in medical toxicology ~600 physician members of ACMT, all of whom are board certified in medical toxicology 3 1
4 Unintentional and Intentional Drug Overdose therapeutic drugs; drugs of abuse; overthe-counter medicines; vitamins Envenomations snake bites, spider bites, scorpion stings Ingestion of Food-Borne Toxins Botulism, marine toxins (e.g. paralytic shellfish toxin, ciguatoxin) Ingestion of Toxic Plants / Mushrooms 4 5 Drug abuse management in-patient care for acute withdrawal from addictive drugs and outpatient Medical Review Officer services for industry and organization Hazardous Exposure to Chemical Products Pesticides, heavy metals (e.g. lead, arsenic, mercury), household products (e.g. cleaning agents), toxic gases (e.g. carbon monoxide, hydrogen sulfide, hydrogen cyanide), toxic alcohols (e.g. methanol, ethylene glycol), and other industrial and environmental agents Independent Medical Examinations assessing injury or disability resulting from toxic exposures 5 Emergency departments, ICU's, other in-patient units Outpatient clinics, offices, job sites Poison Control Centers Medical Schools, universities, and clinical training sites Industries and corporations (e.g. chemical, pharmaceutical) Governmental agencies (ATSDR, CDC, FDA, DHS) Clinical and forensic laboratories 6 6 2
ACMT is a professional, nonprofit association of physicians with recognized expertise in medical toxicology. The ACMT is dedicated to advancing the science and practice of medical toxicology. About 600 board certified or board eligible physicians www.acmt.net 7 30 fellowship programs across the US 2 years in length, average 2 fellows/year Generally affiliated with Poison Centers and academic medical centers Serve as educational sites for many emergency medicine residents in the US Other rotating trainees include: Pediatrics, critical care, medical students, pharmacy students, Pediatric emergency medicine fellows 8 Alaska Guam Hawaii Puerto Rico 9 3
10 Tom Martin, MD University of Washington Seattle, WA Region 10 Portland, OR Andrew Monte MD University of Colorado Denver, CO Region 8 Denver, CO Jennifer Lowry, MD Children s Mercy Hospitals and Clinics, Kansas City Region 7 Mark Mycyk, MD Northwestern University School of Medicine, Chicago Region 5 Chicago, IL Detroit, MI Indianapolis, IN Cincinnati, OH Charles McKay, MD, Fellowship Director Medical Toxicology University of Connecticut Region 1 and Network Director Boston, MA Hartford, CT Worcester, MA * Timur Durrani MD University of California San Francisco, CA Region 9 San Francisco, CA San Diego, CA Sacramento, CA Phoenix, AZ Lewis Nelson, MD Fellowship Director Medical Toxicology NYU Medical School Region 2 Anthony Pizon, MD New York, NY Long Island, NY University of Pittsburgh Region 3 Kapil Sharma MD University of Texas Southwestern Dallas, TX Region 6 Philadelphia, PA Hershey, PA Charlottesville, VA Dallas, TX Michael Beulher, MD Paul Wax, MD Executive Director ACMT Michael Kosnett, MD ACMT Coordinator for ACMT/ATSDR Cooperative Agreement Carolinas Medical Center Charlotte, NC Region 4 Atlanta, GA Nashville, TN Charlotte, NC 11 Poisoning is an interaction between a host, the environment, and a toxin or toxicant An exposure pathway must be completed in order to have toxicity Exposure to a given compound generally results in predictable, often fairly specific host responses (toxidromes) Dose determines effect Large scale exposures require large doses Mere detection of a compound does not identify it as the culprit 12 12 4
It is often difficult to distinguish between toxicity and host physiological responses Causation vs. Association General vs. Specific Causation The proper care of large numbers of poisoned patients correctly balances the potential role (including benefit and risk) of Decontamination Supportive care Diagnostic studies Antidote therapy 13 13 More than 80 courses presented in last 10 years throughout the country More than 9000 participants Contributions by more than 100 medical toxicologists 14 14 Intro/Background Neurotoxins Toxic Gases Cyanide & Fumigants Delivery of Agents by Food/Water/Drug Supply Delayed Toxic Syndromes Radiation Psychological Aspects Agricultural Chemicals Break-out Sessions PAPRs High-Fidelity Simulations Radiological survey instruments Tabletop exercise Environmental Monitoring Post-Event Biomonitoring OSHA First Receiver Guidance Regulatory Aspects and Local Implementation 15 5
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