downsjw2000's profile picture. Internist, #OccEnvMed physician, and medical toxicologist ☠️. Army doc. No exposure➡️No effect. Opinions my own.

John W. Downs MD MPH

@downsjw2000

Internist, #OccEnvMed physician, and medical toxicologist ☠️. Army doc. No exposure➡️No effect. Opinions my own.

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1/ Toxicologists are familiar with loperamide toxicity, but this hasn’t spread as much to other specialities. Thus, my 1st attempt at #tweetorial for #medtwitter . H/T to @jmmarraffa & @DavidJuurlink & @Pete_Wu for their earlier writings. Thxs to @officialdrk12 for the idea


John W. Downs MD MPH รีโพสต์แล้ว

It’s October - hockey season - so let’s talk about a hockey/pulmonary case: A previously healthy 17yo presents with dyspnea, frothy sputum, & orthopnea that began after playing hockey. In the ED he is tachycardic, tachypneic, mildly hypoxic. He has crackles bilaterally. Dx? 1/

nickmmark's tweet image. It’s October - hockey season - so let’s talk about a hockey/pulmonary case:

A previously healthy 17yo presents with dyspnea, frothy sputum, & orthopnea that began after playing hockey.

In the ED he is tachycardic, tachypneic, mildly hypoxic. He has crackles bilaterally.

Dx?
1/

Thanks to @ZiadKazzi and @Em2Kiernan for having me yesterday for med tox academics at Emory to talk about intersection of toxicology, epidemiology, and policy in the glyphosate cancer controversy.

downsjw2000's tweet image. Thanks to @ZiadKazzi and @Em2Kiernan for having me yesterday for med tox academics at Emory to talk about intersection of toxicology, epidemiology, and policy in the glyphosate cancer controversy.

John W. Downs MD MPH รีโพสต์แล้ว

Sending text messages and emails does not replace being present at a leader- go see and talk to the people you lead. If your a leader and people don’t recognize you that’s a problem #Presence


John W. Downs MD MPH รีโพสต์แล้ว

MedTox Fellows. Remember hexavalent chromium salts as cause of nasal septal perforations for board exams.

Causes of Nasal Septal Perforation ▶️Cocaine use ▶️Prior trauma/surgery ▶️Granulomatosis w/ Polyangiitis ▶️Sarcoidosis ▶️Complication of infection (fungal sinusitis) ▶️Complication of malignancy ▶️Others #Neurosurgery #ent #radres #futureradres #MedTwitter #NeuroTwitter

daniel_gewolb's tweet image. Causes of Nasal Septal Perforation

▶️Cocaine use
▶️Prior trauma/surgery
▶️Granulomatosis w/ Polyangiitis
▶️Sarcoidosis
▶️Complication of infection (fungal sinusitis)
▶️Complication of malignancy
▶️Others

#Neurosurgery #ent #radres #futureradres #MedTwitter #NeuroTwitter


Thank you @IronBirds for helping to restore my spirit after a long day of work. 🍿 🌭 ⚾️

downsjw2000's tweet image. Thank you @IronBirds for helping to restore my spirit after a long day of work. 🍿 🌭  ⚾️

John W. Downs MD MPH รีโพสต์แล้ว

MedTox Fellows: Xylazine, an alpha2 agonist like clonidine, is commonly found in illicit drugs (varies across US). FDA reports associations with skin necrosis at injections sites (tinyurl.com/5yjpbw65), and many claims such as:

SteveCurryMD's tweet image. MedTox Fellows: Xylazine, an alpha2 agonist like clonidine, is commonly found in illicit drugs (varies across US). FDA reports associations with skin necrosis at injections sites (tinyurl.com/5yjpbw65), and many claims such as:

Causes of Nasal Septal Perforation ▶️Cocaine use ▶️Prior trauma/surgery ▶️Granulomatosis w/ Polyangiitis ▶️Sarcoidosis ▶️Complication of infection (fungal sinusitis) ▶️Complication of malignancy ▶️Others #Neurosurgery #ent #radres #futureradres #MedTwitter #NeuroTwitter

daniel_gewolb's tweet image. Causes of Nasal Septal Perforation

▶️Cocaine use
▶️Prior trauma/surgery
▶️Granulomatosis w/ Polyangiitis
▶️Sarcoidosis
▶️Complication of infection (fungal sinusitis)
▶️Complication of malignancy
▶️Others

#Neurosurgery #ent #radres #futureradres #MedTwitter #NeuroTwitter


John W. Downs MD MPH รีโพสต์แล้ว

What if the robot knows this is a bad CCB overdose presenting as a sepsis mimic, and insulin truly is the answer 😮

machine learning indicates that insulin is more important than antibiotics for treating sepsis 🙄🤭😂



John W. Downs MD MPH รีโพสต์แล้ว

Rubbing camphor on your chest may help ease a cough, but ingesting it can lead to dangerous neurological instability. Credit: Dr. Aaron Bola #MedTwitter #medicine #emergencymedicine

Core_EM's tweet image. Rubbing camphor on your chest may help ease a cough, but ingesting it can lead to dangerous neurological instability. 

Credit: Dr. Aaron Bola 

#MedTwitter #medicine #emergencymedicine

John W. Downs MD MPH รีโพสต์แล้ว

We had so much fun at the South Hill Chamber of Commerce Fall Crawl event on Saturday!🎃 Catch us in Dinwiddie, Lunenburg, and Midlothian this week!☠️ Got an event that you'd like for the Virginia Poison Center to attend? Reach out to us at [email protected]

VAPoisonCenter's tweet image. We had so much fun at the South Hill Chamber of Commerce Fall Crawl event on Saturday!🎃

Catch us in Dinwiddie, Lunenburg, and Midlothian this week!☠️

Got an event that you'd like for the Virginia Poison Center to attend? Reach out to us at poisoncenter@vcuhealth.org

John W. Downs MD MPH รีโพสต์แล้ว

Here's my comparison of the 2 vasodilator scavengers used for vasopressor refractory distributive shock: 🟥hydrocobalamin vs 🟦methylene blue Which has more evidence? What are the pros/cons? If you want to learn more I'll be giving a talk on this at #ResusX next week! #FOAMed

nickmmark's tweet image. Here's my comparison of the 2 vasodilator scavengers used for vasopressor refractory distributive shock:
🟥hydrocobalamin vs 🟦methylene blue

Which has more evidence? What are the pros/cons?

If you want to learn more I'll be giving a talk on this at #ResusX next week! #FOAMed

John W. Downs MD MPH รีโพสต์แล้ว

Does your house have lead-based paint?🏠 #DYK many homes built before 1978 contain lead-based paint on both interior and exterior walls? When lead-based paint gets old, it can start to peel, chip, or crack and become a hazard. #LeadFreeKids #NLPPW2022 epa.gov/lead/protect-y…

VAPoisonCenter's tweet image. Does your house have lead-based paint?🏠
#DYK many homes built before 1978 contain lead-based paint on both interior and exterior walls? When lead-based paint gets old, it can start to peel, chip, or crack and become a hazard. #LeadFreeKids #NLPPW2022 

epa.gov/lead/protect-y…

John W. Downs MD MPH รีโพสต์แล้ว

Here’s a story about grit, determination, and the best of @ArmyMedicine. When people ask us— Why #MilPeds? Why NCCPeds?— this is one of our reasons (and worthy of our 1st ever 🧵) 1/6

NCCPeds's tweet image. Here’s a story about grit, determination, and the best of @ArmyMedicine. When people ask us— Why #MilPeds?  Why NCCPeds?— this is one of our reasons (and worthy of our 1st ever 🧵) 1/6

John W. Downs MD MPH รีโพสต์แล้ว

MedTox Fellows: All of the plants, below, can cause tachyarrhythmias, bradyarrhythmias/blocks and bidirectional ventricular tachycardia. Four plants also cause hyperkalemia. Which does NOT cause hyperkalemia? @toxandhound #FOAMed #FOAMtox

SteveCurryMD's tweet image. MedTox Fellows:  All of the plants, below, can cause tachyarrhythmias, bradyarrhythmias/blocks and bidirectional ventricular tachycardia. Four plants also cause hyperkalemia. Which does NOT cause hyperkalemia? @toxandhound #FOAMed #FOAMtox

John W. Downs MD MPH รีโพสต์แล้ว

Am aware of 4 NaNO2 poisonings from internet-purchased product in suicides/attempts in Phoenix area over last few yrs; undoubtedly are more. We train medics to carry & use methylene blue, but recognizing MetHbemia in apneic comatose patient without hx of ingestion is difficult.

Last Friday, CBS cancelled a segment about our clients suing Amazon for selling suicide kits to their now deceased kids. CBS’ cowardice gave me renewed clarity about how urgent this litigation is. 🧵@naomi_leeds 1/



John W. Downs MD MPH รีโพสต์แล้ว

🚨DON'T TAKE THE CHALLENGE🚨 Capsaicin is the compound found in spicy peppers that is part of the Paqui "One Chip Challenge." Read more: today.com/parents/parent… Call Poison Help at 1-800-222-1222 today if you have questions or concerns! #onechipchallenge2022 #Poisonhelp

VAPoisonCenter's tweet image. 🚨DON'T TAKE THE CHALLENGE🚨
Capsaicin is the compound found in spicy peppers that is part of the Paqui "One Chip Challenge." 

Read more: today.com/parents/parent…

Call Poison Help at 1-800-222-1222 today if you have questions or concerns!
#onechipchallenge2022 #Poisonhelp

John W. Downs MD MPH รีโพสต์แล้ว

💊 October is #NationalMedicineAbuseAwarenessMonth. Tips to help you: ✅Read all medication labels & warnings ✅Look for the active ingredient ✅Follow the directions ✅Ask your physician or pharmacist to explain the medication ➡Call us with questions 1-800-222-1222

VAPoisonCenter's tweet image. 💊 October is #NationalMedicineAbuseAwarenessMonth.
Tips to help you:
✅Read all medication labels & warnings
✅Look for the active ingredient 
✅Follow the directions
✅Ask your physician or pharmacist to explain the medication
➡Call us with questions  1-800-222-1222

John W. Downs MD MPH รีโพสต์แล้ว

No one more deserving of this #Teaching award! LCDR (Dr.) Robinson is the best! @AcpNavy @NavyMedicine @USUhealthsci @ACPinternists

LCDR Sara Robinson was recognized as the 2021-2 Navy ACP WRNMMC Teaching Faculty of the Year at IM Noon Report while she was on IM wards! One of her MULTIPLE awards! #LadiesOfID @AcpNavy @carlie_cerne @RessnerRose @AliceBarsoumian @brianheartseli1 @YunHeather @CalvanoTatjana

d_blyth's tweet image. LCDR Sara Robinson was recognized as the 2021-2 Navy ACP WRNMMC Teaching Faculty of the Year at IM Noon Report while she was on IM wards!  One of her MULTIPLE awards!  #LadiesOfID @AcpNavy @carlie_cerne @RessnerRose @AliceBarsoumian @brianheartseli1 @YunHeather @CalvanoTatjana


John W. Downs MD MPH รีโพสต์แล้ว

“Six human beings, all of them my patients, one of them my best friend, are dead because they took medicine that I prescribed for them,” one doctor wrote. slate.com/news-and-polit… via @slate


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