Visiting Resident Medical Toxicology Rotation

This is a two to four week didactic elective in medical toxicology available through The New York City Poison Control Center (NYCPCC). The elective in medical toxicology is available to residents from any medical specialty from any region of the country (and from most of the world). The rotation is organized and supervised by Mark Su, M.D., along with the Poison Control Center and Medical Toxicology staff.

General Objectives

  • Familiarize oneself with the structure and function of a regional Poison Control Center.
  • Understand poisoning prevention techniques, including those for household, occupational and iatrogenic poisoning.
  • Develop information retrieval and problem solving skills.
  • Develop a general approach to the identification and management of an undifferentiated poisoned patient.
  • Gain an in-depth understanding of several commonly encountered poisons.
  • Develop an understanding of the role of the toxicology laboratory.
  • Reinforce the comprehension of pharmacokinetics and toxicokinetics.
  • Learn to read and interpret the medical toxicology literature.

Specific Learning Objectives

  • To identify and  discuss the initial identification and management of a poisoned patient.
  • To describe  the rationale and role for administration of oxygen, naloxone, dextrose, thiamine, and other antidotes, and understand the risks associated with their administration.
  • To evaluate and apply  the appropriate methods of gastrointestinal decontamination to  a poisoned patient. Specifically, understand the risks, benefits, indications and contraindications of:
    • Cathartics
    • Whole bowel irrigation
    • Orogastric lavage
    • Activated charcoal
  • Define toxic syndromes (toxidromes) for patients with opioid, sympathomimetic, anticholinergic, and cholinergic agent poisoning.
  • Create a differential diagnosis for drugs causing abnormal vital signs. Specifically:
    • Tachycardia and bradycardia
    • Tachypnea, bradypnea, and hyperpnea
    • Hypertension and hypotension
    • Hypothermia and hyperthermia
  • Create a differential diagnosis of drugs that cause cardiac dysrhythmias and myocardial dysfunction.
  • Create a differential diagnosis of drugs that cause agitation, coma, seizures, delirium, psychosis and ocular abnormalities.
  • Understand the evaluation of anion-gap and non-anion-gap metabolic acidoses, with specific reference to poisoned patients.
  • Learn to identify toxins by their odors and other physical characteristics.
  • Learn about less common toxins and the appropriate use of unique antidotal therapy, if available.
  • Learn the indications for extracorporeal drug removal via hemodialysis or hemoperfusion.
  • Understand the diagnosis, management, and complications of withdrawal from ethanol, opioids, sedative-hypnotics, barbiturates, and cocaine.
  • Develop a thorough understanding of the pathophysiology, evaluation, management and disposition of poisoned patients.

Requirements

  • Participation in Poison Center data collection (i.e., callbacks) and teaching sessions.
  • Preparation of a focused, very brief, presentation, with a syllabus.
  • One journal club article presentation
  • Interest! Punctuality!

Schedule

Daily :

  • 9:00 a.m. - 10:30 a.m.: Callbacks at PCC
  • 10:30 a.m – 11:00: Case review with Fellows
  • 12:30 p.m. - 4:00 p.m.: Poison Center Faculty rounds

Every Tuesday:

  • 9:00AM – 10:00AM Rotators’ Conference lecture

Every Wednesday: 

  • 9:00AM – 10:00AM Project Presentations
  • 11:00 AM – noon:  Callbacks at PCC
  • 12:30 pm- 3:00 pm: Fellow led afternoon rounds

1st Thursday of month:

  • 2:00 p.m. - Toxicology Consultants' Conference (regional medical toxicology meeting)

Every Thursday (except for the 1st Thursday of the month):

  • 9:00AM – 10:30AM. - Toxicology Journal Club

Other Responsibilities

Each rotator is asked to prepare and present a brief discussion of a medical toxicology-related subject of individual interest (in consultation with a fellow or faculty member). Rotators will be allowed time for individual research during the daily activities, and given access to library facilities, computerized literature search data base (MEDLINE), and word processing facilities. In addition to the oral presentation we would like to receive an outline and bibliography of the topic. There is no on-call responsibility for the NYCPCC during this rotation.

Application Process

All rotating physicians must provide a letter from their home institution specifying that they are in good standing, and will have their salary and malpractice coverage provided. If this is a problem at your institution, please contact me and we can discuss potential alternatives. Please have the letter forwarded to me at the address below.

Contact

Mark K Su, MD, MPH
Director, New York City Poison Control Center

nycpcctoxrotation@health.nyc.gov
455 First Avenue, Room 123
New York, N.Y. 10016
Fax 212-447-8223