Peter Viccellio- Updates in Emergency Toxicology

Blog Post by Mike Abernethy, Emergency and Flight Physician from Wisconsin.

Hi DevelopingEM’ers.

Today Im reviewing another presentation from Day One in Havana,  Peter Viccellio’s Updates in Emergency Toxicology.

Peter is the vice chairman and clinical director of the Stony Brook University Hospital ED in New York. His areas of research include overcrowding, patient safety, medical errors, head and cervical spine injuries, and residency education.

Peter opened his presentation with a pertinent discussion on the pathophysiology and treatment of alcohol withdrawal. His approach is not solely from the standpoint of current research and literature but from a wealth of personal experience.  Useful algorithms are listed in the attached lecture slides. Lorazepam, librium, phenobarbatal and valproic acid can be used but the big take home message: The cornerstone of severe alcohol withdrawal treatment remains IV diazepam (and lots of it – sometimes > 100mg).

The treatment for alcohol withdrawal has also become problem in a different sense.  Benzodiazepines are the most widely prescribed class of drug worldwide. As a result benzo withdrawal commonly presents to the ED yet is not always recognized.  A good history is imperative.  It can present as altered mental status, especially in the elderly.

The last portion of the lecture addressed the “newer” drugs of abuse – Krokodil, bath salts, K2 and Salvia. As it is in most tox cases, there is no magic antidote-treatment is supportive.

View the presentation videos here.


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