Emergency Medicine News
January 1, 2025
Leon Gussow
Drug-induced hyperthermia requires rapid cooling, with ice water immersion as the gold standard, but many emergency departments lack the necessary equipment. Tarp-associated cooling with oscillation (TACO) is a newer technique that can lower core temperature at about 0.3°F per minute under laboratory conditions, but it has only been studied in exercise-induced or environmental heat stroke in otherwise healthy individuals, not in patients with drug-induced hyperthermia who often have comorbidities and impaired circulation. For asymptomatic toddlers with possible superwarfarin rodenticide exposure, prophylactic vitamin K1 is contraindicated; the appropriate management is discharge and repeat coagulation studies in 48 hours. Ibogaine toxicity should be considered in patients with chaotic cardiac dysrhythmias, especially those with opioid use history, as it can cause both bradycardia and torsades de pointes due to QTc prolongation.
Emergency Medicine News
June 1, 2024
Leon Gussow
Ibogaine, a psychoactive alkaloid from the African shrub Tabernanthe iboga, has shown promise in treating opioid addiction, PTSD, and traumatic brain injury, but its use is limited by cardiotoxicity risks, including QT prolongation and torsades de pointes. Anecdotal reports and animal studies suggest a single ibogaine session can suppress opioid cravings and withdrawal for weeks or longer, with one expert calling it "the most powerful addiction interrupter I've ever seen." However, no convincing studies have confirmed its safety and efficacy. Risk factors for toxicity include hereditary long QT syndrome, electrolyte imbalances, and interacting drugs. Emergency physicians should monitor for QT prolongation and bradycardia.
Emergency Medicine News
June 1, 2009
Leon Gussow
The psychedelic movement of the 1960s and 1970s was sparked not by Ken Kesey or Timothy Leary but by a New York banker, R. Gordon Wasson, who in 1957 became one of the first Westerners to deliberately eat a hallucinogenic mushroom during a shamanic ceremony in Mexico and published his experience in Life Magazine, coining the term "magic mushroom." Andy Letcher's book Shroom debunks myths about psychedelic fungi, including claims that Santa Claus derives from the fly-agaric mushroom or that major religions originated in mushroom cults. The book distinguishes between the unpredictable fly-agaric (Amanita muscaria) and the more predictable Psilocybe species, which contain psilocybin and psilocin.
Emergency Medicine News
December 1, 2003
Leon Gussow
A 25-year-old man was brought to the emergency department from a dance club after vomiting and experiencing visual hallucinations. He had taken a synthetic tryptamine called 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DIPT, street name 'foxy-methoxy'), a designer drug purchased over the Internet. His symptoms included retching, hallucinations, dilated pupils, elevated blood pressure (140/90 mm Hg), and rapid pulse (132 bpm). Treatment with ondansetron and Ativan resolved his condition within five hours. The text describes tryptamines as natural or synthetic compounds with hallucinogenic properties, noting that 5-MeO-DIPT acts rapidly (onset 20 minutes, duration three to six hours) and affects neurological and gastrointestinal systems. No deaths have been reported from this drug, but fatalities have occurred with other designer hallucinogens.