Antimuscarinic toxicity secondary to moist towelettes containing glycopyrronium tosylate: a case report

AbstractGlycopyrronium is an antimuscarinic drug that is available in a moist towelette preparation for the treatment of primary axillary hyperhidrosis, which is characterized by excessive sweating on the palms, soles of feet, and axillary region. Antimuscarinic toxicity is uncommon with therapeutic use. A 25-year-old female presented to the emergency department with urinary retention and visual changes after initiating topical glycopyrronium tosylate therapeutically. She was tachycardic with a heart rate of 115 beats/min and required a Foley catheter for urinary retention of over 1200 mL. She received 1.5 mg physostigmine for antimuscarinic symptoms and her heart rate improved. Despite treatment, she required a Foley catheter for four days with eventual improvement. This case demonstrates side effects of an unusual preparation of glycopyrronium and the need to take a detailed topical medication history in patients with antimuscarinic symptoms

Establishing Consensus‐based Objectives for the Creation of an Opioid Overdose Curriculum for Emergency Medical Services Clinicians

Objectives: Emergency medical services (EMS) clinicians are on the front lines of the opioid epidemic and are often the first health care personnel system to contact patients experiencing opioid toxicity. Although national educational guidelines include opioid toxicity, no specific standardized prehospital educational objectives or competencies exist. The goal of this project was to identify objectives for an EMS opioid toxicity curriculum that could be used for EMS training. Methods: A list of preliminary educational objectives from U.S. EMS training programs was compiled and reviewed by a group of experts. The Delphi method was used to attain consensus on a final list of objectives for an EMS opioid curriculum. Results: A total of 107 opioid-related preliminary objectives were identified and then narrowed down to 81 preliminary objectives after accounting for redundancy. After four successive rounds of evaluating/accepting/rejecting objectives, 18 final objectives were identified and unanimously approved by the expert panel. Conclusion: We identified 18 objectives to serve as a framework for an opioid toxicity curriculum for EMS clinicians. These objectives can serve as a basis for creating a standardized didactic training program for EMS training programs nationwide. Further evaluation will be needed to explore the best means for educational program delivery

Establishing Consensus-based Objectives for the Creation of an Opioid Overdose Curriculum for Emergency Medical Services Clinicians.

Objectives: Emergency medical services (EMS) clinicians are on the front lines of the opioid epidemic and are often the first health care personnel system to contact patients experiencing opioid toxicity. Although national educational guidelines include opioid toxicity, no specific standardized prehospital educational objectives or competencies exist. The goal of this project was to identify objectives for an EMS opioid toxicity curriculum that could be used for EMS training. Methods: A list of preliminary educational objectives from U.S. EMS training programs was compiled and reviewed by a group of experts. The Delphi method was used to attain consensus on a final list of objectives for an EMS opioid curriculum. Results: A total of 107 opioid-related preliminary objectives were identified and then narrowed down to 81 preliminary objectives after accounting for redundancy. After four successive rounds of evaluating/accepting/rejecting objectives, 18 final objectives were identified and unanimously approved by the expert panel. Conclusion: We identified 18 objectives to serve as a framework for an opioid toxicity curriculum for EMS clinicians. These objectives can serve as a basis for creating a standardized didactic training program for EMS training programs nationwide. Further evaluation will be needed to explore the best means for educational program delivery