Dr. Lisa Thurgur and Dr. Paul Rosenberg discuss the common presentation of Renal Colic, with perspectives on the mixed evidence for medical expulsive therapy, the overuse of imaging studies and when we need to worry about the patient who presents with excruciating flank pain. Next, Dr. Thurgur gives us an update on the three most important recent advances in Toxicology for emergency physicians – Lipid Emulsion Therapy, Hydroxocobalamin and Insulin therapy for Calcium Channel Blocker toxicity. Finally, Dr. Rosenberg and Dr. Thurgur discuss the ‘ins and outs’ of body packers. They review the management of both asymptomatic and symptomatic body backers, highlighting common errors and key therapeutic moves to prevent death.

There are widely varying practices when it comes to managing patients who present to the emergency department with Renal Colic. What is the best practice? How far do we need to go with our workups for renal colic patients? How good are we at diagnosing renal colic clinically? Who requires blood work? Who requires which imaging? Who needs consultation and admission? What determines the probability of a stone passing spontaneously? Who should receive medical expulsive therapy and is their good evidence for it’s use?

What’s new in Toxicology? Lipid emulsion therapy as a last ditch attempt to save the life of certain crashing poisoned patients has had a lot of attention from the Toxicology community recently.

For patients who present to the ED with smoke inhalation injuries, many of them will also suffer from cyanide poisoning. Hydroxocobalamin is a new antidote for cyanide poisoning and may be the preferred choice over traditional cyanide antidote kits.

Finally, to close our Tox Update, while high dose insulin therapy has been used for many years in patients with calcium channel blocker poisoning, it’s use requires finesse. Here, Dr. Thurgur gives us the low down on how to use high dose insulin therapy in CCB poisoning effectively.

With an increase in the number of body packers seen in Emergency Departments in recent years, we need to know how to recognize when these patients can potentially die and how to manage them. Dr. Rosenberg and Dr. Thurgur answer questions like what is the best method of GI decontamination? Is there a role for sending a urine tox screen? How do we know when all the packets are passed? What is the best way to manage seizures, severe hypertension and ventricular dysrhythmias in cocaine overdose? What are the indications for surgery in body packers? and many many more…