Dataset Information

Toxic Alcohol Ingestion/Methanol Ingestion.

ABSTRACT:

Introduction

Methanol poisoning is an uncommon life-threatening ingestion associated with significant morbidity and requires prompt diagnosis and management for the best possible outcome. We created a simulation case that challenges learners to analyze case information, construct a differential diagnosis of an anion gap metabolic acidosis, narrow the differential based on reasoning, and empirically initiate management.

Methods

The simulation case was designed for emergency medicine residents and pediatric emergency medicine fellows. The activity began with a brief overview of the monitors, equipment, and simulation experience. First-year residents managed the case as a team of two. Second- and third-year residents and fellows managed the case alone. The learners had 15 minutes to complete a focused history and physical exam, request and interpret labs and studies, provide stabilization of life threats, and initiate specific interventions based on a presumptive diagnosis. The simulation was followed by a 20-minute facilitated debrief session that reviewed key learning points and learner performance based on an evaluation checklist.

Results

Residents completed a six-question, 5-point Likert-scale postparticipation questionnaire. Overall, residents reported a high degree of satisfaction with the simulation experience. The case and debrief were effective in meeting the educational objectives and proved to be an effective modality to fill this educational gap.

Discussion

This simulation experience successfully exposed residents to the uncommon presentation of methanol poisoning. The simulation experience effectively closed the identified educational gap and provided an experiential learning opportunity that accomplished the targeted learning objectives.

SUBMITTER: Wittler M

PROVIDER: S-EPMC6342378 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Toxic Alcohol Ingestion/Methanol Ingestion.

Wittler Mary M O'Brien Mary Claire MC Masneri David A DA

MedEdPORTAL : the journal of teaching and learning resources 20180817

<h4>Introduction</h4>Methanol poisoning is an uncommon life-threatening ingestion associated with significant morbidity and requires prompt diagnosis and management for the best possible outcome. We created a simulation case that challenges learners to analyze case information, construct a differential diagnosis of an anion gap metabolic acidosis, narrow the differential based on reasoning, and empirically initiate management.<h4>Methods</h4>The simulation case was designed for emergency medicin ...[more]

PMID: 30800940

Similar Datasets

Project description:BackgroundPatients ingesting ethylene glycol, isopropanol, methanol, and propylene glycol ('toxic alcohols') often present with non-specific signs and symptoms. Definitive diagnosis of toxic alcohols has traditionally been by gas chromatography (GC), a technique not commonly performed on-site in hospital clinical laboratories. The objectives of this retrospective study were: 1) to assess the diagnostic accuracy of the osmolal gap in screening for toxic alcohol ingestion and 2) to determine the common reasons other than toxic alcohol ingestion for elevated osmolal gaps.MethodsElectronic medical records from an academic tertiary care medical center were searched to identify all patients in the time period from January 1, 1996 to September 1, 2010 who had serum/plasma ethanol, glucose, sodium, blood urea nitrogen, and osmolality measured simultaneously, and also all patients who had GC analysis for toxic alcohols. Detailed chart review was performed on all patients with osmolal gap of 9 or greater.ResultsIn the study period, 20,669 patients had determination of serum/plasma ethanol and osmolal gap upon presentation to the hospitals. There were 341 patients with an osmolal gap greater than 14 (including correction for estimated contribution of ethanol) on initial presentation to the medical center. Seventy-seven patients tested positive by GC for one or more toxic alcohols; all had elevated anion gap or osmolal gap or both. Other than toxic alcohols, the most common causes for an elevated osmolal gap were recent heavy ethanol consumption with suspected alcoholic ketoacidosis, renal failure, shock, and recent administration of mannitol. Only 9 patients with osmolal gap greater than 50 and no patients with osmolal gap greater than 100 were found to be negative for toxic alcohols.ConclusionsOur study concurs with other investigations that show that osmolal gap can be a useful diagnostic test in conjunction with clinical history and physical examination.

Project description:BackgroundChronic alcohol abuse contributes not only to an increased risk of health-related complications, but also to a premature mortality in adults. Myocardial dysfunction, including the development of a syndrome referred to as alcoholic cardiomyopathy, appears to be a major contributing factor. One mechanism to account for the pathogenesis of alcoholic cardiomyopathy involves alterations in protein expression secondary to an inhibition of protein synthesis. However, the full extent to which myocardial proteins are affected by chronic alcohol consumption remains unresolved.MethodsThe purpose of this study was to examine the effect of chronic alcohol consumption on the expression of cardiac proteins. Male rats were maintained for 16 weeks on a 40% ethanol-containing diet in which alcohol was provided both in drinking water and agar blocks. Control animals were pair-fed to consume the same caloric intake. Heart homogenates from control- and ethanol-fed rats were labeled with the cleavable isotope coded affinity tags (ICAT). Following the reaction with the ICAT reagent, we applied one-dimensional gel electrophoresis with in-gel trypsin digestion of proteins and subsequent MALDI-TOF-TOF mass spectrometric techniques for identification of peptides. Differences in the expression of cardiac proteins from control- and ethanol-fed rats were determined by mass spectrometry approaches.ResultsInitial proteomic analysis identified and quantified hundreds of cardiac proteins. Major decreases in the expression of specific myocardial proteins were observed. Proteins were grouped depending on their contribution to multiple activities of cardiac function and metabolism, including mitochondrial-, glycolytic-, myofibrillar-, membrane-associated, and plasma proteins. Another group contained identified proteins that could not be properly categorized under the aforementioned classification system.ConclusionsBased on the changes in proteins, we speculate modulation of cardiac muscle protein expression represents a fundamental alteration induced by chronic alcohol consumption, consistent with changes in myocardial wall thickness measured under the same conditions.

Dataset Information

Toxic Alcohol Ingestion/Methanol Ingestion.

Introduction

Methods

Results

Discussion

Publications

Toxic Alcohol Ingestion/Methanol Ingestion.

Similar Datasets

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