The St.Emlyn’s Podcast Ep 272 - Toxicology, Hyperthermia and the Future of Emergency Care (June and July 2025)
Aug 23, 2025
Dive into the heat of summer emergency medicine as the hosts explore the rising challenge of nitazenes, a new class of potent synthetic opioids. They tackle serotonin syndrome, showcasing its musculoskeletal signs and the importance of rapid cooling in drug-induced hyperthermia. Discover the implications of the new urgent care plan in the UK and the surprising findings on salbutamol for renal colic. Learn about psychonaut culture and risky self-experimentation that can complicate clinical practices. Stay informed in the fast-evolving world of toxicology!
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Manage Severe Serotonin Syndrome Quickly
- If you suspect severe serotonin syndrome focus first on aggressive cooling, benzodiazepines, then consider cyproheptadine.
- Do not exclude the diagnosis solely because clonus or hyperreflexia are absent on exam.
Hunter Criteria Have Limits
- The Hunter criteria muscular signs have poor inter-observer reliability even among experts.
- Rely on the overall constellation of autonomic, neuromuscular and mental status signs rather than a single exam finding.
Psychonauts Self-Experimenting With Drugs
- Greg described 'psychonauts' who self-experiment with psychedelics and potentiating drugs and even hoard cyproheptadine to blunt serotonin toxicity.
- These behaviours increase risk and complicate assessment when such patients present to EDs.