EM Quick Hits 43 Pediatric Cannabis Poisoning, Esophageal Perforation, Brugada, Career Transitions in EM

Topics in this EM Quick Hits podcast Yaron Finkelstein on pediatric cannabis poisoning pitfalls Brit Long on recognition and management of esophageal perforation Jesse McLaren on 3 questions to diagnose Brugada Syndrome Tahara Bhate on QI Corner - we don't want to give anything away for this one! Constance Leblanc on maintaining wellness in career transitions Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Hanna Jalali and Brit Long, edited by Anton Helman Cite this podcast as: Helman, A. Leblanc, C. Bhate, T. McLaren, J. Ling B. Finkelstein, Y. EM Quick Hits 43 - Pediatric Cannabis Poisoning, Esophageal Perforation, Brugada, Career Transitions in EM. Emergency Medicine Cases. October, 2022. https://emergencymedicinecases.com/em-quick-hits-january-2019/. Accessed September 17, 2024. Pediatric cannabis poisoning - The Best of U of T EM Series Since cannabis legalization in Canada there has been a 9-fold increase in pediatric ED presentations due to accidental cannabis ingestion, corresponding with a marked increase in hospitalization. There are currently two peaks at age of ingestion seen: * Toddlers (largely due to visually attractive edible cannabis that is now widely available) * Teenagers (largely due to increased acceptability and availability) The diagnosis of cannabis poisoning can be challenging in some pediatric patients and without a clear history patients undergo many invasive tests and procedures (i.e., CT, LP) in order to assess for the cause of their symptoms. Factors contributing to diagnostic challenge in pediatric cannabis poisoning:  * Delay to onset of symptoms: In young children, the effect of THC is not seen for 30-60 minutes until it is absorbed through the blood-brain barrier. Children will continue to consume cannabis if it is accessible during this delay. * Parents withholding information: Parents may fear the legal implications of admitting the ingestion to healthcare providers. * There is no toxidrome: The clinical picture of cannabis poisoning is quite broad, and can mimic many other conditions including meningitis, encephalitis, non-accidental injury, or brain malignancy. The clinical spectrum of pediatric cannabis poisoning: Currently, there is a mixed picture of how our pediatric patients present. Many have a benign course, and after a short observation period can be discharged home. However, for those patients that have a larger ingestion, or more severe response possible presentations include: * Altered LOA: e.g."sleepier", more difficult to rouse, coma with a GCS of 3 * Gait disturbance * Seizures * Hypothermia * Apnea Treatment of pediatric cannabis poisoning * Many patients will only need a period of observation and discharge after they have returned to baseline. * Others will require supportive care until cannabis is cleared from their system including: * IV insertion and fluid management if they are too obtunded to maintain their intake * Monitoring for glucose, electrolytes, and hypothermia * Intubation required by GCS or if apneic * Benzodiazepines for those presenting with seizures * There is little role for GI decontamination as the clinical manifestations of pediatric cannabis poisoning are delayed beyond the time that GI contamination may be effective