{"id":1100,"date":"2017-01-04T18:29:36","date_gmt":"2017-01-04T23:29:36","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1100"},"modified":"2017-01-04T18:29:36","modified_gmt":"2017-01-04T23:29:36","slug":"ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/","title":{"rendered":"Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC, &amp; More"},"content":{"rendered":"\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/thereveal\/s\/media.blubrry.com\/roshcast\/s\/content.blubrry.com\/roshcast\/Ep_11_Roshcast_Emergency_Medicine_Board_Review.mp3\"><\/audio><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>If you set your goals ridiculously high and it&#8217;s a failure, you will fail above everyone else&#8217;s success. &nbsp;-James Cameron<\/p><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to Episode 11! Hope you all had a fantastic holiday and New Year\u2019s break. With the In-Training Exam (ITE) just a few months away, it is time to kick the studying into high gear! <\/h6>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\">We changed the brief initial Rapid Review to cover topics from all prior episodes for better spaced repetition. In this episode, we go over important mnemonics. Consider pausing the podcast briefly and quizzing yourself as you are listening. Do not forget to check out the blog for the <a href=\"https:\/\/www.roshreview.com\/category\/podcasts\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">other episodes<\/a> as well as a few new <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/tag\/rosh-quiz\/\" target=\"_blank\">Rosh Quizzes<\/a>. Lastly, learn some tricks from the <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/elite-test-taker-profile-ryan-ribeira-m-d-m-p-h\/\" target=\"_blank\">high-scoring test-taker<\/a> Ryan Ribeira, MD.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"201\" height=\"74\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"\" class=\"wp-image-818\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>For <strong>acute lithium ingestions<\/strong>, a concentration of 4 mEq\/L or greater requires emergent <strong>dialysis<\/strong>. In <strong>chronic lithium ingestions<\/strong>, a level of greater than 2.5 mEq\/L requires emergent <strong>dialysis<\/strong>. Additionally, any patient with neurologic findings secondary to the ingestion requires treatment.<\/li><li><strong>Lead poisoning<\/strong> is treated with either <strong>succimer<\/strong> or <strong>IV EDTA<\/strong>. Remember the mnemonic &#8220;it sucks to eat lead.&#8221;<\/li><li>For <strong>wide complex tachydysrhythmia<\/strong> in a patient presenting with an <strong>amphetamine<\/strong> <strong>overdose<\/strong>, you should administer&nbsp;<strong>sodium bicarbonate<\/strong>. Do not forget to address the <strong>agitation<\/strong> with <strong>benzodiazepines<\/strong> and the hyperthermia with cooling, which will also help control symptoms.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Now onto this week\u2019s podcast<\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 1<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An 88-year-old man with Parkinson\u2019s disease presents confused. He is using a rivastigmine patch as part of his therapy but has mistakenly put on five patches. What physical examination finding would you expect to see in this patient?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. Constipation&nbsp;<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. Dry skin<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. Lacrimation<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. Mydriasis<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Organophosphate-toxitiy-SLUDGE-DUMBELLS-CHOLINERGIC-toxicity-1.jpg\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Teaching image<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Anticholinergic-toxidrome-1.jpg\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 2<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What is the most common cause of superior vena cava syndrome?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. Goiter<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. Indwelling central venous catheter<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. Malignancy<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. Thrombosis<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Superior-Vena-cava-Syndrome-SVC-syndrome.png\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 3<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A pH of 7.1, HCO<sub>3<\/sub> of 15 and PCO<sub>2<\/sub> of 30 is best described by which of the following primary acid-base disorders?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. Metabolic acidosis<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. Metabolic alkalosis<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. Respiratory acidosis<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. Respiratory alkalosis<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Metabolic-acidosis-Winters-formula-Delta-gap.png\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 4<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is true in the post-cardiac arrest patient who experiences a return of spontaneous circulation (ROSC)?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. Antiplatelet and anticoagulant therapy should be avoided in post-arrest patients <\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. Post arrest angioplasty or stenting of acute coronary lesions with a normal ECG has been shown to be an independent predictor of survival after cardiac arrest<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. Post arrest prophylactic antiarrhythmic therapy has been shown to reduce adverse events<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. There is no proven benefit to therapeutic hypothermia<\/span><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 5<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A mother delivered a full-term boy in the ED about 30 minutes ago. On exam, he has cyanosis of the distal extremities, as seen above. His mucous membranes and trunk are pink, and he has +2 distal pulses. No murmurs are heard. His remaining physical exam was normal. Which of the following is most likely his pulse oximetry reading?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. 64\u201373%<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. 74\u201383%<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. 84\u201393%<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. 94\u2013100%<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Acrocyanosis2.jpg\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 6<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 53-year-old man presents to the emergency department with vomiting, diarrhea, and abdominal cramping which occurred 1 hour after eating a meal prepared from mushrooms he found growing in the forest. Which of the following most predicts a benign course of disease?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. Absence of neurologic symptoms<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. Dots or scales on the cap of the mushroom<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. Normal serum liver function tests on initial presentation<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Symptoms occurring within 2 hours of ingestion<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Aminita-phalloides-Mushroom.jpg\" target=\"_blank\">Teaching image<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Table-Selected-mushrooms.jpg\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"201\" height=\"74\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"\" class=\"wp-image-818\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>The&nbsp;<strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/cholinergic-toxidrome\" target=\"_blank\">cholinergic toxidrome<\/a><\/strong> is marked by <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/salivation\" target=\"_blank\">salivation<\/a><\/strong>, <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/lacrimation\" target=\"_blank\">lacrimation<\/a>, <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/urination\" target=\"_blank\">urination<\/a><\/strong>, <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/defecation\" target=\"_blank\">defecation<\/a><\/strong>, <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/gi-upset\" target=\"_blank\">GI<\/a><\/strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/gi-upset\" target=\"_blank\"> <\/a><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/gi-upset\" target=\"_blank\">upset<\/a><\/strong>,&nbsp;and <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/emesis\" target=\"_blank\">emesis<\/a><\/strong>.&nbsp;The most deadly symptoms can be remembered by the killer &#8220;B&#8221;s: <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/bronchorrhea\" target=\"_blank\">bronchorrhea<\/a><\/strong>, <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/bronchospasm\" target=\"_blank\">bronchospasm<\/a><\/strong>, and<strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/bradycardia\" target=\"_blank\"> bradycardia<\/a><\/strong>.<\/li><li>The <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/anticholinergic-toxidrome\" target=\"_blank\">anticholinergic toxidrome<\/a><\/strong> is marked by <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/hyperthermia\" target=\"_blank\">hyperthermia<\/a><\/strong>, <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/mydriasis\" target=\"_blank\">mydriasis<\/a><\/strong>, <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/dry-mouth\" target=\"_blank\">dry mouth<\/a>,<\/strong> <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/urinary-retention\" target=\"_blank\">urinary<\/a><\/strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/urinary-retention\" target=\"_blank\"> <\/a><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/urinary-retention\" target=\"_blank\">retention<\/a><\/strong>, and <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/confusion\" target=\"_blank\">confusion<\/a><\/strong>.<\/li><li>Bronchogenic carcinoma, small cell lung cancer, squamous cell lung cancer, and lymphoma are all common malignancies that can cause <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/svc-syndrome\" target=\"_blank\">SVC syndrome<\/a><\/strong>.<\/li><li><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/dyspnea\" target=\"_blank\">Dyspnea<\/a> is the most common<\/strong> presenting symptom of <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/svc-syndrome\" target=\"_blank\">SVC syndrome<\/a><\/strong>.<\/li><li>In a <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/metabolic-acidosis\" target=\"_blank\">metabolic acidosis<\/a><\/strong>, you can use Winters\u2019 Formula, which dictates that the pCO2 should be 1.5 times the bicarbonate +8 +\/- 2 for appropriate respiratory compensation.<\/li><li>The mnemonic&nbsp;<strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/mudpiles\" target=\"_blank\">MUDPILES<\/a> <\/strong>can be used to remember many of the common causes of anion gap metabolic acidosis: Methanol, Uremia, DKA, Propylene glycol, Iron or INH, Lactic acidosis, Ethylene glycol, and Salicylates.<\/li><li>For the causes of&nbsp;<strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/non-anion-gap-metabolic-acidosis\" target=\"_blank\">non-anion gap metabolic acidosis<\/a><\/strong> remember HARDASS: Hyperalimentation, Addison\u2019s disease, RTA, Diarrhea, Acetazolamide, Spironolactones, and Saline infusion.<\/li><li>In patients with <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/post-cardiac-arrest-ROSC\" target=\"_blank\">post-cardiac arrest ROSC<\/a>,&nbsp;<a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/cardiac-catheterization\" target=\"_blank\">cardiac catheterization<\/a> <\/strong>should be considered even in the setting of a normal EKG.<\/li><li>In <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/cardiac-arrest\" target=\"_blank\">cardiac arrest<\/a><\/strong>, Automated External Defibrillator (AED) use, early bystander CPR, Amiodarone in shock-resistant ventricular tachycardia or ventricular fibrillation, and therapeutic hypothermia are all proven interventions to improve outcomes.<\/li><li><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/acrocyanosis%20\" target=\"_blank\">Acrocyanosis<\/a><\/strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/acrocyanosis%20\" target=\"_blank\"> <\/a>is a transient blue discoloration of the hands and feet, which can occur when a newborn is cold. Typically the pulse oximetry reading is normal.<\/li><li><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/amanita-mushrooms\" target=\"_blank\"><em>Amanita<\/em> mushrooms<\/a><\/strong>&nbsp;produce a deadly renal and hepatic toxin: the amatoxin.<\/li><li><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/amatoxin-poisoning\" target=\"_blank\">Amatoxin poisoning<\/a><\/strong>&nbsp;leads to 4 stages of symptoms culminating in liver failure. Mortality is commonly cited as 10-30%. &nbsp;Activated charcoal and hemoperfusion can be considered.<\/li><li>The<a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/amanita-genus\" target=\"_blank\"> <\/a><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/amanita-genus\" target=\"_blank\"><em>Amanita<\/em> genus<\/a><\/strong> of mushrooms can be identified by <strong>dots or scales on their cap<\/strong>.<\/li><\/ul>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\">From Post-ROSC cardiac care to toxic mushroom ingestion, this concludes episode 11. Let us know how to make this even better by sending Please send feedback to <a href=\"mailto:Roshcast@roshreview.com\">Roshcast@roshreview.com<\/a>&nbsp;\u2014 we want to hear your feedback to keep improving this podcast. Do not forget to check out the high-yield questions and explanations in the <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/specialties\/emergency-medicine\/\" target=\"_blank\">Rosh Review Emergency Medicine Qbank<\/a><span>.&nbsp;<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Until next time,<br>Jeff and Nachi<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">P.S. If you missed last week&#8217;s episode on spider bites, you can catch up here:<\/p>\n\n\n\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/roshcast\/content.blubrry.com\/roshcast\/Ep_10_Roshcast_Emergency_Medicine_Board_Review.mp3\"><\/audio><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Welcome back to Episode 11! Hope you all had a fantastic holiday and New Year\u2019s break. With the In-Training Exam (ITE) just a few months away, it is time to kick the studying into high gear! We changed the brief initial Rapid Review to cover topics from all prior episodes for better spaced repetition. In this episode, we go over important mnemonics. Consider pausing the podcast briefly and quizzing yourself as you are listening. Do not forget to check out the blog for the other episodes as well as a few new Rosh Quizzes. Lastly, learn some tricks from the high-scoring test-taker Ryan Ribeira, MD.<\/p>\n","protected":false},"author":11,"featured_media":1101,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2069,2131,2132,2133,2166,2289,2296,2297,2325,2326,2380,2426,2490,2538,2546,2586,2717,2837,2936,3027,3078,3081,3126,3346,3484,3504,3610,3716,3717],"coauthors":[],"class_list":["post-1100","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-acrocyanosis","tag-amanita-genus","tag-amanita-mushrooms","tag-amatoxin-poisoning","tag-anticholinergic-toxidrome","tag-bradycardia","tag-bronchorrhea","tag-bronchospasm","tag-cardiac-arrest","tag-cardiac-catheterization","tag-cholinergic-toxidrome","tag-confusion","tag-defecation","tag-dry-mouth","tag-dyspnea","tag-emesis","tag-gi-upset","tag-hyperthermia","tag-lacrimation","tag-metabolic-acidosis","tag-mushroom-poisoning","tag-mydriasis","tag-non-anion-gap-metabolic-acidosis","tag-post-cardiac-arrest-rosc","tag-rosc","tag-salivation","tag-svc-syndrome","tag-urinary-retention","tag-urination"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.4 (Yoast SEO v28.6) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC &amp; More | RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 11), the first question and answer style emergency medicine podcast. Listen and learn more.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC, &amp; More\" \/>\n<meta property=\"og:description\" content=\"Welcome to RoshCast (Ep. 11), the first question and answer style emergency medicine podcast. Listen and learn more.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/\" \/>\n<meta property=\"og:site_name\" content=\"RoshReview.com\" \/>\n<meta property=\"article:published_time\" content=\"2017-01-04T23:29:36+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Roshcast-Episode-11-Feature-Image.png\" \/>\n\t<meta property=\"og:image:width\" content=\"519\" \/>\n\t<meta property=\"og:image:height\" content=\"460\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/\"},\"author\":{\"name\":\"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.\",\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/#\\\/schema\\\/person\\\/a838e825547ab58f0be77d446d19338a\"},\"headline\":\"Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC, &amp; More\",\"datePublished\":\"2017-01-04T23:29:36+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/\"},\"wordCount\":941,\"commentCount\":0,\"image\":{\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.roshreview.com\\\/wp-content\\\/uploads\\\/sites\\\/2\\\/Roshcast-Episode-11-Feature-Image.png\",\"keywords\":[\"Acrocyanosis\",\"Amanita genus\",\"Amanita mushrooms\",\"Amatoxin poisoning\",\"anticholinergic toxidrome\",\"bradycardia\",\"bronchorrhea\",\"bronchospasm\",\"cardiac arrest\",\"cardiac catheterization\",\"Cholinergic Toxidrome\",\"confusion\",\"defecation\",\"dry mouth\",\"Dyspnea\",\"emesis\",\"GI upset\",\"hyperthermia\",\"lacrimation\",\"Metabolic Acidosis\",\"Mushroom Poisoning\",\"mydriasis\",\"non-anion gap metabolic acidosis\",\"post-cardiac arrest ROSC\",\"ROSC\",\"salivation\",\"SVC Syndrome\",\"urinary retention\",\"urination\"],\"articleSection\":[\"Emergency Medicine\",\"Podcast\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/\",\"url\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/\",\"name\":\"Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC & More | RoshReview.com\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.roshreview.com\\\/wp-content\\\/uploads\\\/sites\\\/2\\\/Roshcast-Episode-11-Feature-Image.png\",\"datePublished\":\"2017-01-04T23:29:36+00:00\",\"author\":{\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/#\\\/schema\\\/person\\\/a838e825547ab58f0be77d446d19338a\"},\"description\":\"Welcome to RoshCast (Ep. 11), the first question and answer style emergency medicine podcast. Listen and learn more.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/#primaryimage\",\"url\":\"https:\\\/\\\/www.roshreview.com\\\/wp-content\\\/uploads\\\/sites\\\/2\\\/Roshcast-Episode-11-Feature-Image.png\",\"contentUrl\":\"https:\\\/\\\/www.roshreview.com\\\/wp-content\\\/uploads\\\/sites\\\/2\\\/Roshcast-Episode-11-Feature-Image.png\",\"width\":519,\"height\":460,\"caption\":\"Roshcast Episode 11\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC, &amp; More\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/#website\",\"url\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/\",\"name\":\"RoshReview.com\",\"description\":\"Free Powerful Rosh Content - Find content that fits you\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/#\\\/schema\\\/person\\\/a838e825547ab58f0be77d446d19338a\",\"name\":\"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/977f46ed31103df4f8dedd47070baa8fcb56b3e1b9e412217d7e5fbb642dd210?s=96&d=mm&r=g75849d0b5b168ef11fedd98d7b20b2f4\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/977f46ed31103df4f8dedd47070baa8fcb56b3e1b9e412217d7e5fbb642dd210?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/977f46ed31103df4f8dedd47070baa8fcb56b3e1b9e412217d7e5fbb642dd210?s=96&d=mm&r=g\",\"caption\":\"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.\"},\"description\":\"Nachi Gupta, MD PhD and Megha Rajpal, MD are emergency physicians with an interest in medical education. They are trying to make the world better one question at a time. Both reside in New York City.\",\"sameAs\":[\"https:\\\/\\\/www.roshreview.com\\\/author\\\/nachigupta\"],\"url\":\"https:\\\/\\\/www.roshreview.com\\\/blog\\\/author\\\/nachigupta\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC & More | RoshReview.com","description":"Welcome to RoshCast (Ep. 11), the first question and answer style emergency medicine podcast. Listen and learn more.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/","og_locale":"en_US","og_type":"article","og_title":"Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC, &amp; More","og_description":"Welcome to RoshCast (Ep. 11), the first question and answer style emergency medicine podcast. Listen and learn more.","og_url":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/","og_site_name":"RoshReview.com","article_published_time":"2017-01-04T23:29:36+00:00","og_image":[{"width":519,"height":460,"url":"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Roshcast-Episode-11-Feature-Image.png","type":"image\/png"}],"author":"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.","Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/#article","isPartOf":{"@id":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/"},"author":{"name":"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.","@id":"https:\/\/www.roshreview.com\/blog\/#\/schema\/person\/a838e825547ab58f0be77d446d19338a"},"headline":"Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC, &amp; More","datePublished":"2017-01-04T23:29:36+00:00","mainEntityOfPage":{"@id":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/"},"wordCount":941,"commentCount":0,"image":{"@id":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/#primaryimage"},"thumbnailUrl":"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Roshcast-Episode-11-Feature-Image.png","keywords":["Acrocyanosis","Amanita genus","Amanita mushrooms","Amatoxin poisoning","anticholinergic toxidrome","bradycardia","bronchorrhea","bronchospasm","cardiac arrest","cardiac catheterization","Cholinergic Toxidrome","confusion","defecation","dry mouth","Dyspnea","emesis","GI upset","hyperthermia","lacrimation","Metabolic Acidosis","Mushroom Poisoning","mydriasis","non-anion gap metabolic acidosis","post-cardiac arrest ROSC","ROSC","salivation","SVC Syndrome","urinary retention","urination"],"articleSection":["Emergency Medicine","Podcast"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/","url":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/","name":"Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC & More | RoshReview.com","isPartOf":{"@id":"https:\/\/www.roshreview.com\/blog\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/#primaryimage"},"image":{"@id":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/#primaryimage"},"thumbnailUrl":"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Roshcast-Episode-11-Feature-Image.png","datePublished":"2017-01-04T23:29:36+00:00","author":{"@id":"https:\/\/www.roshreview.com\/blog\/#\/schema\/person\/a838e825547ab58f0be77d446d19338a"},"description":"Welcome to RoshCast (Ep. 11), the first question and answer style emergency medicine podcast. Listen and learn more.","breadcrumb":{"@id":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/#primaryimage","url":"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Roshcast-Episode-11-Feature-Image.png","contentUrl":"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Roshcast-Episode-11-Feature-Image.png","width":519,"height":460,"caption":"Roshcast Episode 11"},{"@type":"BreadcrumbList","@id":"https:\/\/www.roshreview.com\/blog\/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.roshreview.com\/blog\/"},{"@type":"ListItem","position":2,"name":"Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC, &amp; More"}]},{"@type":"WebSite","@id":"https:\/\/www.roshreview.com\/blog\/#website","url":"https:\/\/www.roshreview.com\/blog\/","name":"RoshReview.com","description":"Free Powerful Rosh Content - Find content that fits you","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.roshreview.com\/blog\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/www.roshreview.com\/blog\/#\/schema\/person\/a838e825547ab58f0be77d446d19338a","name":"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/977f46ed31103df4f8dedd47070baa8fcb56b3e1b9e412217d7e5fbb642dd210?s=96&d=mm&r=g75849d0b5b168ef11fedd98d7b20b2f4","url":"https:\/\/secure.gravatar.com\/avatar\/977f46ed31103df4f8dedd47070baa8fcb56b3e1b9e412217d7e5fbb642dd210?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/977f46ed31103df4f8dedd47070baa8fcb56b3e1b9e412217d7e5fbb642dd210?s=96&d=mm&r=g","caption":"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D."},"description":"Nachi Gupta, MD PhD and Megha Rajpal, MD are emergency physicians with an interest in medical education. They are trying to make the world better one question at a time. Both reside in New York City.","sameAs":["https:\/\/www.roshreview.com\/author\/nachigupta"],"url":"https:\/\/www.roshreview.com\/blog\/author\/nachigupta\/"}]}},"_links":{"self":[{"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/posts\/1100","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/comments?post=1100"}],"version-history":[{"count":0,"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/posts\/1100\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/media\/1101"}],"wp:attachment":[{"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/media?parent=1100"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/categories?post=1100"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/tags?post=1100"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.roshreview.com\/blog\/wp-json\/wp\/v2\/coauthors?post=1100"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}