ANTIDOTE ACE

“Do not bring a live snake to the emergency room” is advice you never expect to hear. Our healthcare hero, Dr Mike, medical toxicologist and emergency room physician breaks down how poisoning, overdoses, and antidotes work in the real world. 🔴 Dr Ben and Friends 

Comedian and true crime enthusiast Paula Kosienski keeps the laughs coming as we move from antifreeze and snake bites to myths, drug testing, and how to avoid accidental medication mistakes.  Dr. Mike, also an addiction medicine specialist, helps us understand some bizarre situations we hopefully never experience!

We get into how toxicology requires detective work: what clinicians can test quickly, what they can’t, and how patterns like metabolic acidosis and osmolar gaps guide treatment before confirmatory levels come back. Dr. Mike explains antifreeze poisoning in plain language, why acetaminophen is still one of the most common overdoses, and what “supportive care” means when there is no magic antidote. We also talk decontamination tools you’ve heard of but probably never understood, including activated charcoal and whole bowel irrigation.  Sounds like fun, right?

Then we zoom out to real-world hazards: snake bites (no, you should not suck venom out, and please don’t bring a live snake to the ER), black widow realities, and social media challenges like Tide Pods and nutmeg that can do serious harm. We also cover drug testing and false positives, including how medications like Wellbutrin can confuse standard urine screens and why a careful med history matters.

If you like smart medical storytelling with clean comedy and actionable safety tips, hit subscribe, share this with a friend who loves true crime myths, and leave us a review so more people can find the show. What poison or overdose myth do you want us to tackle next?

THANKS TO OUR GUESTS:

Dr Mike: emergency room physician, medical toxicologist, addiction medicine specialist

YT/IG/TT: @toxdocx

Paula Kosienski: comedian

IG/TT/YT @paulacomedy

FB: Paula Kosienski

https://nateland.com/pages/paula-kosienski

Subscribe wherever you listen, share this with a friend and leave a review so more people can find honest conversations about healthcare and a little comedy along the way.

This episode was produced by Angie Debelak with post-production editing by Ben Hill Sound.

Thanks for listening to Dr Ben and Friends.  Laughter is the best medicine...unless you're treating bowel or bladder incontinence.  See you next time!

Team Dr Ben

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Transcript

Welcome To Nashville and Meet my Friends!

Dr Ben 0:09

All right, knock knock howdy folks. Hello from Nashville. Welcome to the Dr. Ben and Friends podcast. The podcast dedicated to putting the med in comedy. We're shining a big bright spotlight on everyday heroes of healthcare and comedy. We're here in Nashville. Our music city is rolling out the welcome at live tunes, live dancing, and hot punch lines. I'm your host, Dr. Ben, your friendly neighborhood, board-certified orthopedic surgeon by day, stand-up comedian by night. Today I'm trading bone saws for microphones for a few hours, anyway. Today, sitting next to me is professional comic Paula Kosienski.

Paula Kosienski 0:55

Thank you for having me.

Dr Ben 0:56

Thanks for being here. Her dry humor

Meet Paula And Meet The Tox Doc

Dr Ben 1:00

is more contagious than MRSA, M R S A. She delivers laughs hotter than a post-op fever. Nashville hot chicken style. We're glad Paula's here. And our real-life healthcare hero, Dr. Mike. Now, Dr. Mike's a dedicated emergency room physician and medical toxicologist. We're gonna learn more about that. His dedication is stronger than titanium hardware. That's right. The Dr. Ben and Friends Podcast prescribes 100% comedy with zero copay, folks. Today we're celebrating the healthcare heroes and comics who dedicate themselves to making the world healthier and funnier along the way. Thank you both for joining us. All right, listener, grab your scrubs and your sense of humor.

Paula Kosienski 1:46

Got it.

Dr Ben 1:47

Check.

Dr Mike 1:49

I left mine in the car.

Sponsor: The Needles Group

Dr Ben 1:53

A special thanks to our sponsor, the Needles Group, in beautiful Marco Island, Florida. As a doctor, I know a great needle when I see one, and these realtors are the best in the business. Buying or selling, let the Needles Group inject some serious value into your property game, theneedlesgroup.com. All right, y'all. Let's give it up for Miss Paula. Now, Miss Paula is a clean deadpan comedian who's blossomed here in Nashville. She's originally from North Dakota. You may have seen her dry bar special. She's performed at Ryman Auditorium, been on a cruise ship with Nate Barghetsi, Nateland Cruz. Her pauses are legendary. Straight out of Nashville's comedy scene. I feel like we scored front row tickets to her next set. Welcome, Miss Paula.

Paula Kosienski 2:42

Thank you so much. I'm very excited to be here. I'm very excited to be here with the two doctors because it'll be nice to have another person that I can text pictures to.

Dr Ben 2:52

Hey, what do you make of this? Some free curbside consults. If it's not a broken bone, it's gonna go to me. All right. Now, Miss Paula, Dr. Mike here is a board-certified emergency medicine physician, doctor, and also a medical toxicologist. Uh, what do you think Dr. Mike does?

Paula Kosienski 3:11

I think that he starts the one hit Toxic by Britney Spears.

Dr Mike and Paula Kosienski 3:18

That's my uh that's my my pager note um ringtone. Ringtone, yeah. Really?

Dr Mike, Paula Kosienski, Dr Ben 3:24

You should mention that's very uh can you think of any nicknames you might call uh Dr. Mike here?

Paula Kosienski 3:36

I would say that to me, you are um the toxic boy.

Dr Mike and Dr Ben 3:45

Oh, toxic boy. Oh man. The toxic revenger. How about the tox doc.

Paula Kosienski 3:53

Oh, I think that I will call him the detox detective.

Dr Ben 3:58

Oh, I like it. You do have to be kind of like a detective at times at work, don't you?

Dr Mike 4:04

Absolutely.

Dr Mike and Dr Ben 4:04

That's the fun part about the job. It's like house MD.

Dr Mike 4:07

Yeah, that's what uh that's what one of the spine surgeons calls me.

Paula Kosienski 4:10

Do you have a cane?

Dr Mike 4:13

Maybe.

Dr Ben 4:14

He's always raising cane. He's always raising cane at work. All right, Dr. uh Mike, uh briefly, what exactly do you do?

How Toxicology Training Really Works

Dr Mike 4:23

Well, I wear many scrub caps, as I like to say. So I'm actually triple boarded in emergency medicine, medical toxicology, and addiction medicine. And for fun, I'm a medical review officer. So doing a lot of drug testing interpretation.

Dr Ben 4:35

How does one become an emergency medicine doctor, a medical toxicologist, like as far as like training? Yeah and then what attracted you to those uh areas of medicine?

Dr Mike 4:44

So you have to go to regular medical school, do your four years there, and then you do an emergency medicine residency, which is either three or four years, and then from there you do a two-year medical toxicology fellowship. And then when I got out of that, I the practice pathway for addiction medicine was still open. And since I was practicing addiction medicine already, I was able to petition the board and they allowed me to sit for the exam. So I got another uh credential without having to do the one-year fellowship for addiction.

Paula Kosienski 5:10

Oh, that's pretty cool.

Dr Ben 5:12

That's a lot of training. Why is it three or four years the residency?

Dr Mike 5:16

Yeah, that's a great question. Uh, there's actually uh a discussion currently with the graduate medical education about making them all four years. Approximately 25% of the programs in the world.

Paula Kosienski 5:25

I bet that's really gonna be a popular decision.

Dr Mike 5:27

Oh, yeah, no. I went to a four-year program. So of course I did six years of training. I could have been a surgeon with all the time that I've done uh with a fellowship.

Dr Ben 5:36

Yeah, because you do four years of undergrad to get a bachelor's degree, four years of medical school, yeah, and then three to four years of residency, and then extra training fellowship to be Yeah.

Dr Mike 5:46

It it's a lot of time and uh basically anything to do with drugs, overdoses, poisoning, withdrawals uh is is my two fellowships, and then emergency medicine is Jack of all trades, master of resuscitation.

Air Bubbles And Antifreeze Explained

Paula Kosienski 5:57

Do you know how you would poison someone if you chose?

Dr Mike 6:01

Oh, absolutely.

Paula Kosienski 6:02

Can I tell you what I think I would do and you can give me advice? Absolutely.

Dr Mike 6:06

Oh, I'd love that. Tell me.

Paula Kosienski 6:08

Okay, I was told to stick someone with an air bubble in between their toes. So I was told you guys don't check there.

Dr Mike 6:17

So you would that's you would need a pretty big air bolus to get a to get an embolism from that. So that would be really hard to do.

Dr Ben 6:24

Between the toes.

Dr Mike 6:25

Yeah, between the toes, probably not gonna get it. You would have to need to do it in a line that was already there. It's a lot of air in order to cause an embol an air embolism. Okay.

Dr Ben 6:33

Listen, don't try this at home.

Dr Mike 6:34

Yeah, don't recommend it. That's part of the as Dr. Ben was saying, like a some of what I do is a lot of detective work, right? And because there isn't a like patients come in, I want to be tested for drugs. It's like fantastic. Which ones? They're like, but but I was poisoned. It's like I need a little more information because there's not just like drug tests.

Paula Kosienski 6:52

It would be kind of funny to be like, you're like a victim of poisoning, and you're like, they're like, what are you poisoned with? And you're like, I don't know, why don't you ask the person that poisoned me?

Dr Mike and Dr Ben 7:01

Like when there's probably a lot of true crime. Um, like I heard tell me if this is true, like anti-freeze, like, could uh because it's like tasteless, odorless. Oh no, it tastes good.

Dr Mike 7:13

No, it tastes good, it tastes sweet. Yeah.

Paula Kosienski 7:15

Okay, I've never tasted listener.

Dr Mike and Dr Ben 7:17

Don't taste it. Yeah, don't taste it. That's why dog dogs get sick from it a lot because it tastes sweet and so they eat it. Yeah, no, anti-freeze tastes good.

Paula Kosienski 7:23

Okay, I have a question about that. So there's a dateline episode that I watched that um they put anti-freeze in yellow gatorade because it's yellow.

Dr Mike 7:34

It can be. It depends on the brand.

Paula Kosienski 7:36

It can be. And that that's how it went down. And I'm ever since then, I but what I heard, you should tell me this is true, is it causes excessive thirst. So for literally my entire life, since that episode, whenever I've been offered Gatorade, I drink a small part of it, and then I set my timer for 15 minutes. And if I experience thirst, I don't drink the rest of it, which is pretty, I think, ironic because if you're drinking Gatorade, you're probably pretty thirsty. Is that true?

Dr Ben 8:05

Don't drink an unopened Gatorade that someone gives you, probably. Make sure it's uh Yeah.

Paula Kosienski and Dr Ben 8:09

Well, I mean, I was doing it like from my mom, you know. Like nobody trust no one, trust no one. But is that true? Does it cause excessive thirst?

Dr Mike and Dr Ben 8:18

Not necessarily. Oh, this is just getting how does antifreeze kill somebody? I it's primarily through the kidney, so it it gets so it's ethylene glycol is the antifreeze, and the the toxic metabolite is actually what kills you. It's not the parent compound, and so it gets converted into an acid and then causes crystallization, you know, crystal formation in the kidneys, so you die of renal failure.

Dr Ben 8:39

Wow.

Dr Mike 8:39

That's mostly what it is, and then metabolic acidosis, so lots of things in the world.

Dr Ben 8:43

And that would be determined on like autopsy or something, or no, no.

Dr Mike 8:46

I I can so we can get levels. That's one of the few things we can get levels for, but they take a little bit of time depending on the lab. Um, if it'll come back right away. And the traditional teaching is to actually do for something called an osmolar gap, and you do the calculated versus the expected, and it depends on the story, and then you treat empirically. Um, so I can give them the antidote, which does not allow the parent compound to be converted into the toxic metabolite, and then they'll pee it off. So I can continuously block somebody every 12 hours, and if they're not acidotic, if their blood isn't, you know, acid, uh, then I can reverse them without usually dialyzing them.

Paula Kosienski and Dr Ben 9:21

What what kind of symptoms would a person that's being poisoned with antifreeze have? Um, let me give my notebook. What some urinary symptoms or something?

Dr Mike 9:32

Some urinary symptoms sometimes, but they're just overall not feeling well because they're becoming acidotic.

Paula Kosienski 9:37

So like the probably don't feel good when you're being poisoned to death.

Dr Mike 9:41

No, yeah, it's it's pretty awful. Um, they can have altered mental status and they can have difficulty with their breathing, and it affects their entire metabolism. It's pretty rough.

Paula Kosienski 9:51

So, like in that situation, what's the what's the percent chance that you catch this before? Like, let's say this person wasn't told in advance that they were going to be poisoned. So they don't know.

Dr Mike 10:01

Um Which is hopefully most. Which is if you're trying, if you're the poisoner, you shouldn't.

Paula Kosienski 10:05

They talk crazy, they'll do wild things. Um, but like how how quick, like, what's the percent that you catch in before, you know, it's too late?

Dr Mike 10:14

So what you're looking for, it really depends on like on the story. It's like, I'm suddenly very ill. It's like, oh, I went out to a party. Okay, well, I can check that osmo, the the serum osms, and I'm gonna get the rest of the blood work. And I look at their kidney function, I'm like, something's going on here. And so it's a cause of what's called a high anion gap metabolic acidosis. If you look at the differential for that, like more than half of it is tox causes. So then I get a phone call, like, hey, could this be? I'm like, could be. So let's send the test, let's treat them, I'll get it taken care of. So they call me and I come in and save the day and tell them what to do.

Paula Kosienski 10:46

Pretty cool.

Dr Ben 10:46

But it's the bat signal.

Dr Mike and Paula Kosienski 10:48

Have you ever had a situation where you like someone comes in and then the I mean, to be fair, poisoning is like more of a girl's thing. Um you'd be surprised in the crime world, but killing your spouse is more of a guy thing. So whatever. Um, but do you ever like meet a couple and you're like, I'm pretty sure that guy's trying to kill that girl?

Dr Mike 11:08

I have not, but I've had a mentor that uh had that case and it's in his actual memoir book in New Jersey. Wow. Oh yeah, it it's it's it's something that you could do a movie out of. She was actively poisoning him while still in the hospital, feeding him every day, feeding him poison as well.

Paula Kosienski and Dr Ben 11:24

That's the dateline episode with antifreeze or another poison.

Dr Mike 11:28

This is a different poison. Oh, okay. Well, yeah, yeah. It was uh yeah, it was pretty rough. But he was the top the state toxicologist driving in a blizzard, going down to try to save this person and got and got the antidote out of the chemistry lab because it's used as the stain.

Paula Kosienski 11:44

Uh-huh.

Dr Mike 11:45

So, and so he got it from the yeah, so that was the antidote for the poison. It's it's a stain that's used and can bind it up. And so he tried, and he the person died, and so you know he could talk about it now because the court case is over.

Dr Ben 11:56

Wow. Do we still see like arsenic or cyanide

Cyanide, Detox Tools, And Charcoal

Dr Ben 11:59

poisonings?

Dr Mike 11:59

Oh, cyanide I see a lot, actually. Yeah, it's it's common in fires. Oh, okay. Is that the most common way to get cyanide? That's the more common way of getting cyanide poisoning.

Paula Kosienski 12:07

So, like there's a fire that starts and then you're like end the fire and you breathe it. Yeah, exactly.

Dr Mike 12:12

It's it's the furnace. Inhalation. Yeah, it's inhalation. So it's you can get carbon monoxide and you can get cyanide, and they can be a little sometimes tricky to tell them apart because there's so many things. There, it's you know, in in environmental stuff, it's almost never just one thing. And that's part of like the fun part about my job is most people can handle one thing. It's when you have, I took a bunch of this pill, I took a bunch of this pill, and then it all mixes together in the body, and I have to kind of tease out what effect is coming from which and which is the best way to manage it. That's that's the fun part about being a toxicologist.

Paula Kosienski 12:41

Do you want to hear a funny story about something that I did when I thought I was gonna poison, I thought I poisoned myself? Yes. I took a bunch of I took a bunch of Miralax and I took some Sudafed and I thought that they would react poorly together. And I went to the emergency room and they were like, go home, like you're fine. This is two very normal medications.

Dr Mike 13:02

Well, I mean, in in too much. They can, you know, too much Sudafed can give you some some negative side effects, probably not gonna kill you, but yeah. Oh, what one of the things that we do in terms of detoxifying patients is something called whole bowel irrigation. And that is more about that. Oh, that's sound. It's exactly what it sounds like. So um, it's a very bad day for your nurses. You what you do is you put the order and then you go up to your nurse and say, I'm sorry. Here's a cookie because I just ruined your shift.

Paula Kosienski 13:27

Here's a cookie that you will not be able to keep down.

Dr Mike, Paula Kosienski, Dr Ben 13:30

You have to do literally colonic cleansing. You need to flush it all out. Yep, and you're just trying to flush everything out because you give it early enough. If it's going to be a bad overdose, that could potentially kill somebody. If it's still in their stomach or the first part of their intestine within the first hour or two, I can order that and you basically make them drink or put a nasal gastric tube in. So a tube that goes in their nose. I've had those. Oh, they're awful. Uh, and then force go lightly, the colon prep. And then sometimes what I'll do is I'll do go lightly with a charcoal chaser. So activated charcoal is what we'll use to bind up some toxins. And so, how do you know when you're done? The traditional teaching is when the effluent is clear, um, or when I see the charcoal come out.

Dr Ben 14:09

So it's like a mixologist, a bartender. Charcoal chaser.

Dr Mike 14:14

I it's a charcoal chaser. Yeah, exactly. I mean, it's it's toxic alcohols and regular alcohols. That's my one of my hobbies is regular alcohols, just to collect them. I barely drink these days, but I like you know the taste. We're just tasting, okay.

Dr Ben 14:26

Just the taste. But like uh similar if you have a colonoscopy, the prep what you have to do. Listener, you may have had a colonoscopy. That prep is probably miserable.

Dr Mike 14:34

Oh, it's miserable.

Paula Kosienski 14:36

So the I'm a little confused because the go-lightly makes me feel like it's going out one way. Correct. But then the charcoal makes me think it's going out the other way.

Dr Mike 14:46

So it shouldn't. If you're vomiting charcoal, that's a bad day. Because if it gets into your lungs, that can be very, very bad. So you want everything to go out the back end and you want it to go out the back door nice and dark, hopefully bound up most of the stuff.

Paula Kosienski 14:58

So you don't have you shouldn't be throwing up.

Dr Mike and Dr Ben 15:01

Please don't. Yeah, that's that's not good. We try not to do anything out the top anymore. We try to either push it out or bond your lungs. Exactly. Yeah.

Dr Mike and Paula Kosienski 15:09

And I have a feeling like if you throw up poison, it goes out like your throat. It probably makes it irritated. Sore, yeah.

Dr Mike 15:17

Well, that's the old way of doing it. And in certain areas where there's just not a lot of health care, we still will use syrup ipecac. It was taken off the ambulances more than two decades ago in most places. And that's the way that we used to treat poisonings, is you make them people vomit it out, right? We don't do that anymore. We have medication we can push it through so that it doesn't get absorbed and you're not running that risk, especially if it's like an acid or a base where it can get into your esophagus and cause damage, or potentially, you know, sometimes these medications make you sleepy, and then you vomit, and then you aspirate that, and then you get into the lung. It's a bad day.

Paula Kosienski 15:47

Well, I just gotta say, I've had to try the go lightly before. And if somebody was like, it's this or poison, I would be like, let's try the poison.

Dr Mike, Paula Kosienski, Dr Ben 15:55

Because that's that's not great. No, there's nothing light about go lightly. Yeah, there's nothing. It's a misnomer. It's false advertising. Yeah, it's just it's just a little pinch, it's just a little prick. You're gonna be a little sore afterwards, right? No, go ahead, go heavy.

Paula Kosienski 16:09

Because the taste, you're like, this is this is poison.

Dr Ben 16:13

They should make it more palatable.

Paula Kosienski 16:14

Yeah, they should use it.

Dr Ben 16:16

Make it taste more like antifreeze.

Dr Mike 16:17

Well, there's sorb. So there are sorbitol ones. Like uh when I give activated charcoal the first round, I'll give it with sorbitol to make it, which will make it sweeter. Um, so I'll do that the first time. And then additional doses, I don't use sorbitol because it'll give people the runs. So it may not be necessary.

Paula Kosienski 16:32

Isn't that kind of what we're trying to do here?

Dr Mike 16:34

Well, in this case we are, but not not every patient needs to have that discomfort.

Paula Kosienski 16:39

Gotcha. Okay.

Fake Ads And Real ER Life

Dr Ben 16:46

All right, folks. Thank you, team. Now it's time for common sense healthcare ads. This episode of the Dr. Ben and Friends podcast is brought to you by Toe Jam Jam. Nail fungus, or as Dr. Mike would call it, onacomycosis. Try Toe Jam Jam. Smear mango preserves between your toes and wrap in plastic overnight. The fruit enzymes eat the fungus alive. Dr. Mike, he's a fun guy. Wake up to sweet, smelly victory, or fruit flies. Delicious results guaranteed. Make sure to use Dr. Ben at checkout for 25% off your Toe Jam Jam. You're also emergency medicine physician. Can you kind of paint a picture for like a typical day in the life? Is it like The Pit? Is it uh it can be?

Dr Mike 17:44

It actually, I I actually quite appreciate that show because it can give a representative day. And I've had days at at the hospitals I've worked at that are very similar to that. Um we we can, you know, there's there's a lot of things. We get everything. So chest pain, shortness of breath, headaches, belly pain. My my toe's been hurting me for six months. Right.

Paula Kosienski 18:02

Or like I've chose to go in at Friday at 9 p.m.

Dr Mike 18:06

Yes. It's quite, yeah. Uh or it's like my shoulder hurts. Like, where'd you get your surgery done? Oh, I got it done at this hospital. You do you realize we're not in that system and that your surgeon's not here, right? Get a lot of those.

Dr Ben 18:16

So you'll come in like maybe seven in the morning or seven at night or oh oh me.

Dr Mike, Paula Kosienski, Dr Ben 18:20

Yeah. I'm a six. There's different shifts. Yeah, there's different shifts, and it really depends. And uh, you know, Mondays are the worst. That's like a Garfield thing. I hate Mondays. Really? So yeah, because patient people don't want to come in on the weekend and you know, they're enjoying their weekend, and like, I'll get it taken care of on Monday. So they get they kind of want to ruin their weekend. I don't want to ruin the weekend for their emergent complaints. No, if you're it's actually emergent, of course, we're gonna take care of you very quickly, but there's things called triage where we see, you know, how serious is this, and unfortunately, sometimes you're gonna have to wait for somebody that's sicker. Um, but Mondays, if you can avoid the ER on Mondays, we would appreciate that.

Dr Mike and Dr Ben 18:53

Do you do the triage or the nurses do the triage? Okay, nursery triage. Do you know what that is, triage?

Paula Kosienski 18:58

I know what triage is. It's where you look at all the patients and you go, you are less important and you are more important.

Dr Mike 19:05

It's not important, it's you're less dire.

Paula Kosienski and Dr Ben 19:08

You're less valuable. No, no, not even that.

Dr Mike 19:10

Not even that. Every life is valuable, it's just certain complaints need to be addressed more quickly than others. Right.

Dr Mike and Dr Ben 19:16

It's fresh. You could die of chest pain, but you're not gonna die of a toe that hurt for six months. Yeah. Unless unless it's, you know, osteo.

Dr Mike, Paula Kosienski, Dr Ben 19:22

Gangrenous of getting toxic. Um, that's for me.

Dr Mike 19:26

Yes.

Paula Kosienski 19:27

Have you ever had to do like uh have you ever been on the stand before, like been called as an expert witness?

Dr Mike 19:33

Oh, yeah, absolutely.

Paula Kosienski 19:34

Uh tell me about it.

Dr Mike and Paula Kosienski 19:35

I can I can give you some vague details. I can't talk about specific cases, but but I've I've done some cases. Um, most of them are family law related these days. Oh, that's upsetting.

Dr Ben 19:45

Well, I mean it's all like a spouse trying to kill somebody.

Dr Mike 19:47

Oh, I wish. Oh it's not no, I hope I don't want anybody killing anybody, but uh keep that part. No, no, no, no, no. It's it's mostly like is this person fit to take care of another person based on their drug testing? Oh so, or is somebody was somebody intoxicated at the time of an injury accident, etc.? So I'll do some defense cases, calculate, you know, calculate what their alcohol level may or may not have been within a certain range at the time of an incident.

Dr Ben 20:14

Does that make you nervous being deposed?

Dr Mike, Paula Kosienski, Dr Ben 20:17

Not when I'm the expert. Not when I'm the expert. Oh, yeah, I know you swear in, but it's actually quite tell the truth. Oh, absolutely, nothing but the truth. Okay. Oh, it's really so helpful. So help me God. Yeah.

Dr Ben 20:26

Could we swear him in for our podcast?

Dr Mike and Dr Ben 20:29

Please raise your right hand. Raise your hand, but do you have a siddur? I don't use the Bible.

Paula Kosienski 20:35

Um, do you uh okay, did you did you pay attention to the Karen Read case?

Dr Mike 20:40

I don't know who that is.

Paula Kosienski 20:41

Oh, you're missing out. This is right off your wheelhouse.

Dr Ben 20:44

Give us the synopsis.

Paula Kosienski 20:46

Okay, I will. So you guys probably know it. Um she was accused of purposely backing over her husband her boyfriend. But if you have two brain cells that you rub together, that's not what happened. Um the trial, she got she got convicted or not guilty. She got convicted. She was found not guilty. She was found not guilty. But the reason that I bring it up for you is because she was like most definitely drunk while driving. And so, like the question was like, did she was she so drunk that she maybe hit him and didn't know? Um, which is also no, she didn't hit him, no collision. But anyway, um, I wasn't sure if you may take your work home with you.

Dr Mike and Dr Ben 21:32

Oh, I try I try not to do that. Take my home. Negligent homoside? But in in these kind of cases, there's two opinions here, right? There's the legal definition of intoxicated and there's the clinical definition of intoxicated. And I get to opine on both, which is really fun as the aspect.

Paula Kosienski 21:47

So what's the difference?

Dr Mike, Paula Kosienski, Dr Ben 21:48

Well, a legal intoxication is over a lab value. Yeah, it's called a per se limit, which is the .08 from a whole blood. So I have to do calculations when I get hospital labs because that's not whole blood. And um, and then there's Clinical intoxication when you're like, oh, I'm drunk. And then otherwise we're having a normal conversation like this, but there may be alcohol involved. So you would say, like which there isn't, but could be now that's that's respondent?

Paula Kosienski 22:10

Speak for yourself.

Dr Mike 22:12

It's fun, it's a lot of detective work, and that's why I do it. Because at the end of the day, I emergency medicine is nights, weekends, holidays, flipping flopping here, go into different places, and it can burn you out. And so having this other uh related career that is very cerebral, uh, it it really does help with my longevity.

Dr Ben 22:34

Did that ever make you want to go into law? Being having those depositions, it's kind of they speak with their own language. Medic medical medicine has theirs and law has theirs. And I'll watch like suits and be like, man, that law looks like fun.

Dr Mike 22:47

You know, it's actually really fun being the expert. I don't want to be dealing with writing briefs and things like that, but you know, you have to write opinions. And so you get a little bit of that. It's like writing like an essay for college again because you have to like cite sources and things like that. But I I like what I do part of it because I get to be part of the team and part of the, you know, the the thought process. And because you're you have one piece of this case. They're looking at it from a you know 10,000 or 20,000 point view, and I have my little piece. So you get to play around a little bit um and and be part of that and understand the strategy.

Paula Kosienski 23:19

Do you play more for the defense or the offense?

Dr Mike 23:21

I usually do more defense.

Paula Kosienski 23:23

Okay.

Dr Mike 23:23

From the med-legal stuff.

Paula Kosienski 23:25

Yeah, because they're like, my my girl's not drunk. This guy will tell you. And then you go up and you go, she's fine.

Dr Mike 23:31

I don't, I don't, I don't, I don't say it like that. I I need I need some I need some evidence. I can't just say, like, yeah, they're not drunk. It's like, okay, well, what's the evidence? I didn't see them.

Dr Ben 23:40

Uh Dr. Mike, what are some of the more common um toxicities and poisonings that you encounter and see, both in the ER and as a medical toxicologist?

Courtroom Toxicology And Intoxication Math

Dr Mike 23:50

Oh, yeah. Most commonly it's Tylenol.

Paula Kosienski and Dr Ben 23:52

Tylenol, no way.

Dr Mike and Dr Ben 23:53

Yeah, Tylenol is one of the biggest because it's in everything. And the and the joke that we have intentional and unintentional. Yeah, exactly. Exactly. Because it's easy to get and you know, and it's pretty easy to overdose on. And it's a the the funniest thing is when we go to our national tox conferences, we're still talking about Tylenol management.

Dr Ben 24:10

And how does that patient present?

Dr Mike, Paula Kosienski, Dr Ben 24:11

Uh, that's a delayed toxicity, which is why it's so dangerous. Right. That's why we check it out. Tell us about that. That's why we check for it. So it's mostly a liver toxin, but it can affect the kidneys. Um, and so it can cause obviously uh liver failure and then kidney failure. And then when your liver fails, then you start to puff up because you you know you get endematous and then your brain can swell and you the way you turn yellow. Turn yellow. That's right. So it it there is an antidote, and we can give that through the IV or we can give it orally, but would it be fun if the antidote was just ibuprofen?

Paula Kosienski 24:41

That'd be pretty fun.

Dr Mike 24:42

That's a different toxicity that causes that causes renal failure. That one's a little harder to overdose on in terms of like the milligrams per kilogram that you would need.

Paula Kosienski 24:51

It's that's actually really good news because tylenol never works. I feel like Tylenol is just one big joke and it's like a placebo, and it's just nothing in there helpful.

Dr Mike 25:00

Now, can you say what the generic term the name is?

Paula Kosienski 25:02

Yeah, acetaminophine. Well done.

Dr Mike and Dr Ben 25:04

Well done. Dr. Paula. Well done.

Paula Kosienski 25:06

Uh have my way around some ibuprofen and acetomination. Acetaminophen.

Dr Mike and Dr Ben 25:10

Well, what's second on the list of common alcohol? I can get a lot of alcohol.

Dr Mike, Paula Kosienski, Dr Ben 25:17

Yeah, that one's more fun, but it's like you can get an alcoholic, you know, ketoacidosis. And so is it actually a toxic alcohol or regular alcohol? Um, a lot of patients uh will come in on their overdose on their psych medications. So we'll get benzos, we'll get their you know, antidepressants, we'll get their antipsychotics, those are fairly common. Um, then we'll get the environmental exposure. So I'm the guy that takes care of snake bites. So we're gonna have snake bite seasons soon. So I get I get all the Tell us about that. Oh, those are those we we get a lot of them at at one of the hospitals you and I both work at. They get they get transferred in to go see a hand surgeon.

Paula Kosienski 25:50

Is it true that you have to like suck the snake? Bring this well that to you, but like Nate Bargatze has a joke about how then you have to like bring him the snake.

Dr Mike 25:58

Please don't bring me the snake.

Paula Kosienski 26:00

He's like, you gotta catch this snake, and do you so what do you do?

Dr Mike 26:04

So if you've been bitten by a snake, do not try to suck out the poison. It's already around. You're gonna put your dirty mouth on it on an open wound. Okay, yeah. So you're gonna potentially infect a wound, which which please don't do that.

Dr Ben 26:15

Okay, listener, do not suck the poison out.

Dr Mike 26:16

Do not suck the poison out. I know that's what they say uh on Archer. You know, I've seen that episode of Archer. It's like, don't do that. I think we've all seen that. Please don't do that. Um, a constriction band if there's going to be a delay in care. Do not put a tourniquet on, but a constriction band.

Dr Ben 26:31

Okay, tell us so like tell the listener how to do a constriction band.

Dr Mike 26:34

A constriction band would be well, if you have like a hair tie or something like that, something that type, but not a true tourniquet.

Dr Mike and Paula Kosienski 26:40

Because a tourniquet will cut off all blood flow. Correct. And you don't want all blood flow, you just don't have to be able to do that. Why would you go to medical school?

Dr Mike 26:46

You're amazing.

Dr Ben 26:46

A deadlimb. You'll get an ischemic limb.

Paula Kosienski 26:48

That's a lot of problems.

Dr Ben 26:50

Okay.

Dr Mike and Dr Ben 26:51

Educated consumer over here. A constriction ban if you're gonna if you're gonna have a delay in you know, this is if you're bitten and you're an hour away from your closest medical facility. Go to the medical facility, try to snap a picture of the snake, you know. Just yes, yes, no. Like a selfie, get a selfie with it. I wouldn't probably get a selfie with it. I wouldn't probably get a selfie. Use a selfie stick. Exactly, a selfie stick. Just try to get a picture of it. This way we know what it is. Right. Uh, we know what we're dealing with. And but please do not bring a live snake to the emergency room. That has happened to me.

Dr Mike, Paula Kosienski, Dr Ben 27:18

Oh, really? They've brought it in Really? the pocket.

Dr Mike 27:20

Yeah, they've done that. I'm like, oh god, no. They're like, Do you want to see it? No, I do not want to see the snake. Don't bring that in my emergency room. That was this was when I was a fellow in California. So they would bring in the Western Diamond Backs. So it's like, no, I know what it is. Just take a picture.

Paula Kosienski 27:33

I know what it is.

Dr Mike and Dr Ben 27:34

What are you bringing me the snake for? We're not bringing the snake in there.

Paula Kosienski 27:36

You're like, this is like the one harmful snake in this area. I know what this is.

Dr Mike 27:39

Yeah, please, please don't do that. And so I'll get blood work and we'll uh then you know, if it looks like a what's called a wet bite, so a venomous bite, poisonous. Poison is something that you ingest, venomous it's injected into you. There's the difference.

Paula Kosienski 27:52

See, I thought I thought poisonous was like uh something that so like my sister's like all into amphibians or whatever, and poisonous uh something that is like a touch versus like I thought venom was something that was like injected. Injected into you. Yeah, okay.

Dr Mike 28:08

Venom is something that's put into you by and and poison is something that you put in you, like it's ingested.

Dr Ben 28:14

Yeah, versus yeah, injected, like a snake will inject venom into you.

Paula Kosienski 28:18

Like if I touch a poisonous frog, it goes through my skin. That would is that considered ingested?

Dr Mike 28:24

Well, because it's not injected into you, it's not like it's a they're trying to get you, you're doing it to them, right?

Paula Kosienski 28:29

Okay, so it's like a consent thing.

Dr Mike, Paula Kosienski, Dr Ben 28:30

Yeah, it's a consent thing. Don't touch the don't touch it, like, yeah, don't lick toads. Don't lick especially poisonous frogs. Alright, I'll stop. No, well, people will do that, right? There's there's some psychedelic toads and they'll get confused for the cane toad. And that's actually a um, it's a dejoxin like toxicity. So it's a heart toxicity. Oh yeah. Don't lick toads just don't lick toads.

Dr Mike and Paula Kosienski 28:48

It just makes it's a if one thing is if you're licking toads, maybe just switch to like meth or something.

Dr Mike and Dr Ben 28:54

Please don't use meth. I do meth. Or don't do that. That's a whole nother conversation. That's my third job is meth. Number three. That's my third job. That's the addiction. Um, so you were asking about what other things that I see. Um, so we can do the snake bites, we'll do some spider stuff.

Paula Kosienski 29:07

Uh what about a brown recluse?

Dr Mike 29:10

So brown recluses, we see them quite commonly here.

Paula Kosienski 29:13

And they don't kill you all the time.

Dr Mike 29:15

No, not usually, but it it can be a prolonged healing process because again, it's an envenimation and it causes ulceration.

Paula Kosienski 29:22

And it happens all the time.

Dr Mike and Dr Ben 29:23

All they don't want to an infection, not usually infection, but it might need debridment because it'll escar. Okay. And so you might need to have a surgeon debride it and then maybe need to get a skin graph depending on the size of it.

Dr Ben 29:35

What would be a deadly uh spider bite that you see?

Dr Mike and Paula Kosienski 29:38

Not not many here. Thank God. We're not in Australia.

Dr Ben 29:42

But in Australia.

Dr Mike 29:44

Oh, yeah. Every so so I had an I had an attending um it back in in Philadelphia when I was a resident. His name's Steve Walsh. And like he's Walsh's rules of toxicology. Rule number one, don't trust, you know, don't mess with the KGB. Okay, that's rule number one. Don't mess with the KGB.

Dr Ben 29:58

Good device.

Dr Mike 29:59

Yeah, rule number two. Everything in Australia is trying to kill you. Yeah. Kangaroos, snakes, and things like that. And then like I think don't quote me on rule number three, but like, you know, an acetylcysteine fixes everything, which is one of the jokes of toxicology. Benzos and an acetylcysteine is most of our antidotes.

Dr Ben 30:17

What about the black spider? Or the black widow?

Speaker 30:20

The black widow doesn't usually kill you. It's uh mostly pain meds and and anti-anxiolytics or benzos. Um, we we we do have an anti-venom for it. It's hard to get, it's quite expensive and has a lot of side effects. And so I will use it um on the very old or the very young when they're having uh secondary problems, like they're having a heart attack from all the pain, and and they're just you know, they're they're they're they're very agitated, and the other meds aren't helping them. So that's when I'll potentially do that. But but in general, it's supportive management. Here's your tox fellowship in about 30 seconds, okay? Supportive care.

Dr Ben 30:54

Which means what to the listeners, and to the orthopedic surgeon.

Paula Kosienski 30:57

Validating them.

Dr Mike 30:58

Yeah, well, not just yes, yes, you have to validate them. We don't we don't give them ANCEF. Okay, that's for our ortho, that's that's an ortho thing, okay?

Dr Ben 31:05

That is definitely an ortho thing.

Dr Mike and Paula Kosienski 31:08

It's whatever they're dealing with. So if their blood pressure is low, support their blood pressure with medications, fluids, etc. You know, if they're they need a breathing tube, you put a breathing tube in to help with their oxygenation. You know, the body is Mother Nature's one smart broad. She can detox a lot of stuff. And if we can support somebody through a toxin, then sometimes they'll be okay. Sometimes they will not be okay or go back to normal, but we can support you through it because there is no antidote. Um, so supportive care is the patient in see in you see in front of you. Most emergency physicians can handle that bit of it. So they're the ER docs are good at the supportive management piece. Uh so that's number one of toxicology. Number two is uh, you know, try to decon the patient, so detoxify the patient if that exists. So decontaminate, so stop the exposure. And then if you can detoxify them, that's amazing if there is a real antidote. Uh benzos for agitation, anxiety, and half the time what we're using anyway. And then N-Acetylcysteine, which is the antidote for Tylenol and good for your liver for pretty much everything else. That's the majority of Toxworld, and that's the joke that we tell within ourselves is Ativan uh benzos?

Dr Ben 32:10

Yes, it is good. Valium, Ativan Xanax.

Dr Mike 32:14

Oh, yeah.

Tylenol Overdose And Snakebite Truths

Dr Ben 32:15

Dr. Mike, uh, I feel like kind of we still are in an opioid crisis. Yes. Are we seeing a lot of uh opioids and fentanyl overdoses?

Dr Mike 32:26

And yeah, that that's my yeah, we do a lot of that in the emergency room. And as a toxicologist and addictionologist, addic uh opioid addiction is still a very big thing. And then fentanyl makes it particularly tricky because it's really dangerous. It's really dangerous. It's um it's very potent. So you do not need a lot of it in order to get a clinical effect.

Paula Kosienski 32:46

I have a crazy fentanyl story. Oh so my mom and my sister came to Utah, Salt Lake City to watch me when I recorded my Dry Bar, and we stayed at this hotel at the airport, and this stupid airport. Uh, we left or or I I flew out and they were going to the mall for the day. And the airport, I guess it just like gave out their room keys to random people. Oh my gosh. And then they came back at the end of the day. And it was this whole thing they realized like through the front desk that oh, the like ten other guys that have been here all day are not part of your party. And they went into the room and they had this really weird smell. So they called the police, and the police came and tested the room, and there was fentanyl. And they told my parents or my sister and my mom to like throw away everything you don't absolutely need and wash everything else you have in hot boiling, very warm water.

Dr Mike 33:39

Because they you thought they were gonna overdose by touching the fentanyl?

Paula Kosienski 33:43

The police were, yeah, because the the room had tested positive for traces of fentanyl.

Dr Mike 33:48

Okay. Is that possible, Dr. Mike? Oh, this is this is one of my favorite things to debunk. Okay. Uh touching, touching fentanyl does not is not gonna give you an overdose. We have these very expensive fentanyl patches for a reason. It's a whole drug delivery technology. Okay. If it would be a whole lot easier if I could just do this and rub my fingers together and get toxic for fentanyl, it doesn't happen. Okay, I've actually debunked the myth. Yeah, I've actually done that in front of cops before. They're like, oh my god, it's fentanyl. Don't touch it. Transdermal, you're gonna it's transdermal. It's like I gave myself Narcan. It's like if you're giving yourself Narcan, you did not need the Narcan. This is real. I've seen this before many times, unfortunately, because it's misinformation.

Paula Kosienski 34:24

And I think they should be more clear about that because I think about that a lot. Like I touch in doorknobs, like in seedy places as a comedian. Oh, okay. And I go, that probably has fentanyl on it, probably gonna die.

Dr Mike 34:36

No, no. Your skin barrier is pretty good about not absorbing the fentanyl.

Dr Mike and Dr Ben 34:40

What if you have a cut on your finger? Probably be okay. So be okay. I think you'd be fine. All right. Yeah, you're not you're not gonna absorb all the things. What if you like the scenarios?

Paula Kosienski 34:47

You snort it.

Dr Mike 34:49

That can get you in trouble. That can get you in trouble. Mucous membranes are a good way of absorbing things. Okay. My favorite ones are the well butrin ones that that they crush up their well butrin and snort it and they come in seizing. Oh, yeah.

Paula Kosienski 35:01

Well butrin's fun enough, just taking it as directed. You don't need to up it.

Dr Mike 35:05

So wellbutrin, if you look at its structure, and this is what we do as toxicologists, we look at the chemical structure of it, it has the same backbone as a as a khathinone. So khat, kh a t it's from the Middle East. And do you remember like the the I am I'm the captain now from that movie? He's chewing something that's khat that he is chewing. Oh, and so it's a synthetic khathinone, which is uh was what well butrin is. So it has a similar structure to methamphetamine. So that's why it's a stimulant, it's a stimulant. Okay. And you'll your drug screen will be positive. Yeah, yeah. It's a good one. Don't snort it. And your your your standard urine drug screen will flag you for meth if you take well butrin. And so that's a consult that I get. It's like the patient, you know, patient positive tested positive for meth. Like they didn't use meth. That's their well butrine. This is a hospital drug test, which are not great from a forensic perspective. And so I'll go and this is something that I'll defend patients in the hospital so that they don't get the diagnosis of a substance use disorder. Right? I get a lot of these calls, and just to, you know, they'll the the team will ask me that why did they test positive for this? Like, well, that's all the quercine they were taking, or they were that's all the well-butrin that they're taking. Ah, so that's the a good medication history is important in my world.

Paula Kosienski 36:13

So if you have asthma, you could also get away with being a meth addict.

Dr Mike 36:17

No. No, definitely not.

Paula Kosienski 36:21

Um you have to be low-key about it.

Dr Mike and Dr Ben 36:24

I I I wouldn't use meth ever. Don't ever use that.

Paula Kosienski 36:27

Yeah, no, I'm not saying you should. I'm just saying it sounds like maybe you could.

Dr Mike and Dr Ben 36:31

I mean, asthmatics don't necessarily get that much benefit from meth. Now, well butrin.

Paula Kosienski 36:36

No, right. What I'm saying is like they take well butrin, right?

Dr Mike and Dr Ben 36:39

Not necessarily. Wellbutrin is for anxiety and depression. Oh, I totally for your mood. Yeah.

Paula Kosienski 36:45

I totally thought we were.

Dr Mike, Paula Kosienski, Dr Ben 36:46

For smoking sensations. Smoking cessation. Yeah. What's the one they have in inhalers? So that's actually interesting that you bring that up. Um, there it's the there is a brand of vapohaler that has traditionally had the enantiomer, which is because there's something called chirality here. So the left side and the right side are the same molecule. So it is L-methamphetamine. Good for you for knowing that. So it is actual methamphetamine, but it's the L, that's the enantiomer in the way that we remember it is L for legal. Um, so that'll be a defense that I'm when I'm doing forensics work, they'll say, well, it was the it was this version. And so then I have to get additional testing for the chirality. So if it comes back, it's um I've never had a successful defense of this because I have to go after it. Um, they this is what they claim, and it just delays the inevitable, and then it all comes back in the D in antiomer. But yes, that is that is what is that use for? Okay, the vapohaler?

Dr Ben 37:43

The L one, the legal one.

Dr Mike 37:45

The illegal one is it's for allergies. Oh, for allergies, yeah. Okay. It's a it's an inhaler. I'm not gonna tell you the brand.

Dr Ben 37:51

Okay.

Paula Kosienski 37:51

No, it's I'll tell you the brand.

Dr Mike and Dr Ben 37:54

Does it have any of the similar uh effects of the not really? Okay, that's why it's safe to use, and that's why it's still relegated. Isn't that amazing? Yeah, it's the same, but just the mirror image. Yeah, it doesn't work as well. Left and right.

Paula Kosienski 38:06

Because all it does is just uh doesn't it just like make your blood vessels bigger?

Dr Mike and Paula Kosienski 38:10

Yeah, it's a bit it's a dialator. Good job. Thanks. Well done.

Dr Ben 38:14

Wow.

Paula Kosienski 38:14

All right, call me Dr. Paula, Dr.

Dr Ben 38:17

Paula. All right.

Fentanyl Touch Myth And Drug Tests

Dr Ben 38:20

Are we seeing any um like horror stories from like um kids on social media trying challenges and ingesting Tide Pods and don't do this listener?

Paula Kosienski 38:30

So good.

Dr Mike 38:31

I I did a whole lecture for paramedics like a couple years ago for our regional paramedics, and it's it was all about the challenges that people are doing.

Dr Ben 38:40

Tell us about the dangers of those.

Dr Mike and Dr Ben 38:41

Yeah, don't do the Tide Pod challenge. That can that can kill people die. Yeah, people can die from that um because it's a it's a it breaks down surfactant, right? It's a detergent, it's gonna you know cause cellular damage and break down the membranes. And if you inhale it, the surfactant is what allows your lung to slide. And so if it doesn't allow that, then you can't breathe. You can't breathe, you can't exchange oxygen, so it's really bad. And it can cause burns. So if it's left on for too long, it can cause mouth burns or it can cause skin burns because that goes crazy. Yeah, that's real. There's the nutmeg challenge.

Paula Kosienski 39:12

Yes, that one was so bad.

Dr Mike and Dr Ben 39:14

It's really, it's yeah, it's it's not good. Uh people will try to do that. What are people doing with nutmeg eating it? Listener. Yeah, don't do it. Um, interestingly, uh so there's maristocin, which is in which is in nutmeg, and if you ingest enough of that, which I do not recommend because you can it it'll kind of get you a little high. It's a little bit a little psychedelic. Right.

Paula Kosienski 39:35

All right, all you bakers out there get crazy.

Dr Mike 39:38

Yeah, yeah, with a nutmeg.

Dr Ben 39:39

A little spice and seasoning's okay, but yeah.

Dr Mike 39:41

Oh no, that's fine. Yeah, you it so so Paracelsus (Zurich, 1493), that's who we always quote, the the original toxicologist. Like the dose makes the poison, is what you know, is what we shorten it down to. Everything is toxic, everything is poison, it just depends on the dose. Even even my jokes, they're toxic after too long.

Paula Kosienski 39:58

Not even that big of a dose.

Dr Mike and Dr Ben 40:01

Shots fired. Shots fired. Leave the comedy up to the professional.

Dr Mike 40:06

Listen, I'm not good enough to do stand-up, I sit down.

Dr Ben and Paula Kosienski 40:09

He does sit down comedy. I am good enough to be an ER doctor.

Dr Ben 40:15

Uh

Viral Challenges And Dose Makes Poison

Dr Ben 40:16

Dr. Mike, tell us about like some uh like accidental poisonings, like uh any interesting stories of unintentional accidental poisonings that the listener can kind of um any precautions we can take to avoid accidental poisoning.

Paula Kosienski 40:31

Anything that at night we can think about and for maybe on and worry about for the rest of our lives.

Dr Mike and Paula Kosienski 40:36

So the so the most of my accidental poisonings are people using an over-the-counter medication outside the bounds of what's written on the label. Read the directions. Read the directions. If it's not if it's not working for you, don't take more of it. Right? Because like I said, the dose makes the police. Tylenol.

Dr Ben 40:52

Yeah, you can three grams or three thousand milligrams or four.

Dr Mike, Paula Kosienski, Dr Ben 40:56

It's it's I we usually just keep it to three thousand for most of the three thousand milligrams a day, listener. Yeah, and then keep an eye on things like if you take Tylenol and then you go take a cough medication that has multiple medicines, there's usually Tylenol in that. So it's that's where it gets you in trouble, is because you're not paying attention to all of the sources of right. So you take Tylenol, you take your percocet, you take your you know, your cough medicine, and I'm not a person's gonna have a great night. It could be the DXM, the dextromethorapin, robo tripping. Well, that's a fun one.

Dr Ben 41:23

Robo tripping.

Dr Mike 41:24

Oh, I had a kid one time that got brought in by their grandfather, and he's like, I can't feel my legs. It's like, well, they're there. But it's I talked to grandpa. I'm like, what happened? He's like, Well, he was having a cough earlier and I gave him some medicine. I'm like, did it have dextromethorphan? And he's like, Here, let me show you. I'm like, you accidentally overdosed your grandson. So he'll be fine. It's just that's what it was. Wow. Yeah.

Dr Mike and Dr Ben 41:43

So the dextromethorphin can get you very high and cause some neurologic symptoms as well.

Dr Mike and Paula Kosienski 41:49

Yeah, it's they're high. They're just that high. Just that high.

Paula Kosienski 41:53

So the it seems like the lesson to be learned is people need to do this more. Turn it around, look at the active ingredient on the label, and make sure that you're not taking a ton of medication with the same active ingredient. Use as directed. Use as directed. Yeah.

Dr Ben 42:09

Yeah. That if you have to take a picture with your phone, then zoom it in.

Dr Mike 42:12

Yeah, I can't.

Dr Ben 42:13

I can't read those bottles. Yeah, I can't.

Dr Mike 42:15

Yeah. And magnify the exact formulation actually does matter because you know, the certain brands will have different versions of what they have. This one contains Tylenol, and this one contains Tylenol and aspirin.

Paula Kosienski 42:25

Right.

Dr Mike 42:26

So when I, as an ER doctor, I need to know if you have a, you know, if you fall and break, you know, crack your skull and have a head bleed. I need to know if you're on aspirin or not, because I got to do something about that. It's like all I do is take Tylenol. It's like, actually, you take a Tylenol, aspirin. I'm like, oh, okay, that actually changes things for me. Wow.

Paula Kosienski 42:39

So, like, I think of like those medications where it's got two medicines in it as like a fast food place that's like a Taco Bell and a KFC situation and connected, you know? Or like just one or the other. Like, it's too complicated when you take like all of them together.

Dr Mike 42:56

It can be. It can mean that again, that's what I do as a toxicologist. So it's like they've taken a bit of this, a bit of this, a bit of this, and they took this yesterday. So, how much of that is pulling into today? And that's that's the fun part about my job is you get to play the detective.

Paula Kosienski 43:08

That is

Fake Ad- Common Sense Healthcare

Paula Kosienski 43:16

now it's time for some common sense healthcare ads we wish existed. This episode of Dr. Ben and Friends is brought to you by the Forget Me Not Helmet. Memory loss? Check out the Forget Me Not Helmet. Wear a colander on your hand with tinfoil. It blocks brain draining 5G waves. Recall everything or nothing. We're not sure. Conspiracy fans Approved.

Dr Ben 44:01

I love it. Would that be helpful, Dr. Mike?

Dr Mike and Dr Ben 44:05

Tin foil from any I won't give you aluminum toxicity, thank goodness. It's not actually made from tin, it's made from aluminum.

Dr Ben 44:21

All right. Any other advice for listener on preventing accidental or unintentional poisonings or toxicities?

Dr Mike and Dr Ben 44:28

If you're not sure, talk to your doctor. Hopefully your doctor is very professional and is writing you the appropriate dose. And uh yeah, just be careful with what you're doing. Child-proof your house. Child-proof oh please, yeah. Don't let don't let your kids get into the medicine. Tessalon Perles, they look like candy. So especially medicines that come like. That's for coughing.

Dr Ben 44:49

What happens if someone ingests too many?

Dr Mike 44:51

Tessalon pearls are basically a local anesthetic. Oh my god. It's a local anesthetic toxicity, is what it causes.

Dr Ben 44:57

What would happen?

Dr Mike 44:57

That they can have they'll have seizures and and uh heart uh bad rhythms of their heart so called cardiac dysrhythmia, because it causes blockade of the sodium channel.

Dr Mike and Dr Ben 45:06

So I've seen some really common remedy for coughing. Yes, but in excess, it can it can be very bad for a child.

Dr Mike 45:11

So I one of my practice patterns is I always ask if I'm gonna write it, are there young children in the house? And if there's young children in the house, I won't prescribe it, or I'll make sure that they lock it up.

Dr Ben 45:20

Wow.

Dr Mike 45:20

Yeah, because it it it looks like candy, and I've I've seen bad things happen to kids when they get into this.

Paula Kosienski 45:24

Oh, they should not be making it look like candy.

Dr Mike 45:26

It looks like candy.

Paula Kosienski 45:27

Yeah, you should fix that.

Dr Mike 45:29

It's a pearl. It's a pearl. But it's again when things are used appropriately, they're they're they're good. But it's when they're used inappropriately and a child doesn't know any better necessarily.

Paula Kosienski 45:38

Right. Well, it just feels like we fixed that. Seems like a packaging issue. I feel like that could be fixed.

Dr Mike 45:42

And so that is part of things that we do in toxicology, is we advocate um that's why blister packs exist, right? Because keep kids from yeah, it makes it a little harder and it keeps things more organized. So not just kids, but our older population who may have some memory issues, they might say, Do I take my medicine today? Ah, the blister pack will yeah, the blister pack will help with that because I might accidentally take an extra dose of their medicine. Okay.

Preventing Accidental Overdoses At Home

Dr Ben 46:03

So now to a little role reversal, do you have any uh questions for a couple of professional comedians or a professional comedian that I'll yes?

Dr Mike and Dr Ben 46:11

So I I'm not like I said, I'm not good enough to do stand-up. It's it's like, how do you how do you find like what's your inspiration? How do you get new material? Oh, good question.

Dr Ben 46:20

Paula? Miss Paula?

Paula Kosienski 46:21

Well, I like to go outside and do stuff, get out of my house and hang out with friends, and then you talk about stuff that's happened to you, and you riff off each other, and then you start laughing, and you think I should write that down.

Dr Ben 46:38

That's a funny premise, or that yeah.

Paula Kosienski 46:40

I've it my comedy, if you watch it, is it's not highbrow in terms of like the topics are not crazy. It's not like I'm like thinking about stuff, it's just random stuff that happens, you know, or like uh you make a lot of jokes about your family and then you know, or your friends, or just you do dumb stuff and then you make jokes about that.

Dr Mike 47:04

Got it.

Paula Kosienski and Dr Ben 47:05

So yeah, it's caused me to be a lot more observant to try to look for Yeah, that's a that's a great word for it. It's like you just kind of go through your day and not notice things, but then when you're a comedian, you're like, oh, there could be some material in that, or you're kinda on the lookout for some material.

Paula Kosienski 47:20

If you if you hang out with a comedian, it they'll make comments about everything. And it can be really funny and it can also be extremely annoying. Um when you're like they'll just you just make comments off everything, what something looks like, or you think there is, and you're just trying to like you're just very observant, I guess. Yeah.

Dr Mike 47:37

That makes sense. I've seen some of his stuff, and it's like the Garmin. I'm like, oh yeah, that's true.

Dr Ben 47:41

Some observational, observational comedy, definitely. Um and then I I get a lot of like uh emails with like crazy, and this will be a segment of our show, crazy uh medical headlines. So sometimes I tell about some crazy medical headlines and riff on those.

Dr Mike 48:00

Uh observational and because I'm always struggling to come up. There, there's a nurse over at one of the hospitals, she's like, all right, hit me with your latest one. I'm like, I was just here yesterday. I didn't come up with anything new.

Dr Ben 48:09

He comes up with some good one-liners.

Paula Kosienski 48:12

That's awesome.

Dr Mike 48:13

But they're all medical, and that's my my concern with my little jokes is that they're very specific.

Paula Kosienski 48:19

No, that's good.

Dr Mike 48:20

I mean, but they're for a specific audience, they may not get it. It's mine, I'm not general. I don't my fear is that I'm not too I'm not general enough.

Paula Kosienski 48:27

So here's my opinion: the more niche you are, the better. Because this is maybe more social media, but I think it's true where it's like um general is mildly interesting to everybody, but you're not gonna get anywhere being mildly interesting. So you want to be super interesting to a select group of people, and then you'll get this really intense like group of people that really like your stuff. And then, I mean, I don't know if you do this, but you'll like end up watching, like I remember watching like three hours of videos on cave diving. That's a pretty niche topic, and I don't cave dive, but when you see a group of people get into something, and like even just now, listening to you guys talk, you're like, but this is a world I don't know about, and so it's you want to learn more about it. Yeah, you get people who know about it and can stay on pace, and you get people who don't know about it, but they're really interested because clearly what you're talking about is interesting, and so I think you actually should be more like as niche as possible. Got it.

Dr Mike 49:24

I I told him my Osgood Schlatter joke, and that like slays with the orthopedist, and nobody else knows what it is.

Paula Kosienski 49:30

Yeah, but I'll Google that afterwards again.

Dr Ben 49:32

Listener.

Comedy Process, Codes, And CPR Reality

Dr Ben 49:33

What did you learn about cave diving?

Paula Kosienski and Dr Mike 49:36

Oh, well, I learned don't do it. Um no, step one I learned um that you can get toxicity. So you have to have a certain amount of nitrous in your oxygen if you're gonna go down to a specific depth. But you have these dumb boys who like think that they can go farther than they can, or they don't, uh they don't follow the rules. And so what you do is you can get so far that you can get nitrous, uh uh, I don't know if it's poisoning or if it'd be, I mean, I guess it's poisoning, but it's like you get drunk based nitrogen narcosis. Narcosis, there you go. And so then you get turned around and you'll see people who will, because they're all over the place, they'll just swim all the way down to the door.

Dr Ben and Paula Kosienski 50:16

Disoriented, thinking they're going to disoriented.

Paula Kosienski 50:18

Um, and so that's but you need it to go down to that depth, and it's just a really tricky game.

Dr Mike 50:25

Yeah, and then not only is the nitrogen being absorbed, it's if you don't have a safety stop coming up. If you got on too high of a depth, the bubbles will come out of your blood, and that's how you can get an air embolism.

Dr Mike and Dr Ben 50:37

Yeah, you get the bends. Caissons. Yeah, it's bad. It's it can be very careful coming back up. Yeah, you gotta see divers. Take your take your safety stop.

Paula Kosienski 50:45

I remember learning that on house when the guy was like diving, and then the next day he was in the plane and he got super sick.

Dr Mike 50:52

Yep, can't do that. Yeah.

Paula Kosienski and Dr Ben 50:53

Air embolisms, I just have to say, I had an IV and I thought the little things of air would do that. And I remember like that, it said like on the machine, like air in line. And I was like freaking out one second away from ripping that. I was like, they're gonna try and get me. And then the the nurse had to like explain to me that that's not a big enough air.

Dr Mike 51:15

Yeah, though you're saying between the toes, and like not enough.

Paula Kosienski 51:17

Yeah, but I thought it could be like like a s like a this much of a syringe. Is that enough?

Dr Mike 51:25

Depends on the thickness of the syringe.

Paula Kosienski 51:27

That's it.

Dr Ben 51:28

And where it's going, like where it's in between toes and yeah, just under the skin, probably, but injected into a vein, a bunch of air. Yeah.

Paula Kosienski 51:36

I wonder if it's like, you know, when you have like uh dough and you have bubbles, and if you kind of like shake it, it kind of gets the bubbles out. It's like maybe if you get a put in your toe, then you just shake them. It kind of shakes it out.

Dr Ben 51:51

I'm not sure if it works that way, but it works that way.

Paula Kosienski 51:54

But has anybody tried? I'm just kidding.

Dr Ben 51:57

But if you see people flicking the syringe, oh yeah, they're trying to get it out.

Paula Kosienski 52:00

Yeah, we try to get classic doctor mode.

Dr Mike and Dr Ben 52:03

Exactly. Doctor move. It's like nurse. Teach us that in the medical school. Yeah, exactly. You just gotta make it look good. It's like, well, yeah, and then squirt s some into the air. Exactly. Johnny and Roy from emergency, you pop the two ends off and you squirt it back in.

Paula Kosienski 52:15

When they do the like take the cap off with their mouth.

Dr Mike and Dr Ben 52:20

Oh, yeah, yeah. You gotta make it's all for effect the drama. The drama. I I will run codes sometimes. Uh yeah, tell us what that means, running a code. A running running a code is a resuscitation. A code usually means the person is stop breathing, your heart's not beating. Exactly. So it's CPR and putting a breathing tube in and giving a lot of medications. Um so it it's closed-loop communication, right? It's the same thing that happens in a lot of industries. So, you know, it sometimes uh we'll uh we'll do it like Gordon Ramsay. Okay, so it's more so we'll we'll do it. It's like I need one of epi, like "one of epi heard chef!"

Paula Kosienski 52:58

And so one of Yeah, that makes sense because you have to have that like down really well. You can't it has to be like, yeah, that makes sense.

Dr Mike 53:07

Yeah, and so it's the same skill set. And instead of saying doc, they say chef.

Dr Ben 53:13

But uh those codes, we see those a lot on medical dramas, but oh yeah, yeah, those are pretty accurate.

Dr Ben and Paula Kosienski 53:18

Someone's on the chest pumping their the compressions are always bad.

Dr Mike 53:23

Yeah, well, oh yeah, on TV shows, they're they're bad, yeah. But we have ways of monitoring them with the system, and there's usually an observer that's that's you know giving feedback to the compressor if we're not using a machine compressor. Um codes should be quiet. A good code is quiet because everybody has not mayhem like on tv to be able to do it. Yeah, no, you don't want that. That's not a good code because nobody knows what's happening, and then the team leader can't can't organize their thoughts. And then so this way you can take things, you know, in more information that you're given from your team in order to make the next decision and hear when the next time medication is being given by, you know, or need to be given by your scribe because they're your timer, because things are all protocolized, and then there's um other things that are reversible causes. So sometimes I'll do an ultrasound and take a look at the heart to make sure there's no fluid around it, or sometimes I'll take a look at the heart to see if it actually is beating, and I can call the code. So there's there's multiple reasons for doing ultrasounds in a resuscitation.

Dr Ben 54:14

Listener, everyone should get CPR certified. Yes. Don't learn your CPR from medical dramas because I don't think they're doing chest compressions right there. No.

Paula Kosienski 54:22

I don't understand how they can't do it right. It's probably one of the easier parts to get right because it's like I think like a 13-year-old babysitter kind of knows how to do chest compressions because you gotta get CPR certified. So, how do you know how you can't just get that right? It's so confusing to me.

Dr Mike and Dr Ben 54:36

It's people are afraid to break ribs. Don't be afraid to break ribs in a life.

Paula Kosienski 54:41

Like they don't get the rhythm right. Like, at least get the rhythm right, you know?

Dr Ben 54:44

And in a force.

Paula Kosienski 54:46

Yeah.

Dr Mike 54:46

Yep, it's about going hard, going fast. Just get them.

Paula Kosienski 54:49

Do you remember the first time you ever were like, oh, I'm leading a code for the first time?

Dr Mike 54:53

Yes. So I was 17 or 18 years old. Really? Yeah. Yeah. I was I was an EMT, right? So I was I was working at uh an event venue as the doing the EMS for the venue, and it was a sponsored boxing match. And end of the night, okay, everybody needs to go home. Like, there's a lot of people passed out drunk. It's like, come on, okay, they get up. This guy's like, all right, come on, not getting up. Like, all right, roll them over. Stabbed. Wow. Just like blood coming from his chest, and we're like, what do we do? Oh CPR, Oh CPR.

Paula Kosienski 55:23

Oh my gosh, that's crazy.

Dr Mike 55:26

I was 18 years old, like, live, live. The paramedics show up because I was an EMT basic at the time. The paramedics are like, dum dum dum dum dum, just put the breathing tube in. Hey, medical center, we're coming in with this. Meanwhile, I'm like, don't die on me. Don't die on me. The amount of experience difference was insane. Looking back on it, it's just like looking at myself when I was 18 years old versus me now. I'm like, you're an idiot.

Paula Kosienski 55:49

I think we can all think that.

Dr Ben 55:52

I love it.

Final Takeaways And Where To Follow

Dr Ben 55:53

All right, folks, big thanks for tuning in to the Dr. Ben and Friends podcast from the heart of Nashville. We're celebrating healthcare heroes like Dr. Mike and professional comics like Honorary Dr. Paula. Remember, we can be serious in surgery, but some of us are seriously funny. All right. If you love today's episode celebrating comics and healthcare heroes, join Team Dr. Ben and hit that subscribe button. Your word of mouth is our best support. Tell a friend, your nurse, your doctor. We'd love to hear from you and your friends. Drop your favorite dad joke or general questions at DrBen and Friends.com. We can't wait to feature you in our next episode. All right, Miss Paula. Let's see. How can our listener find you?

Paula Kosienski 56:41

Thank you for asking, Dr. Ben. This is how you can find me. You can find me at my address, but I will not be giving that out. You can also find me, follow me on Instagram. Do it. Follow me on Instagram. At Paula Comedy. Follow me on TikTok. At Paula Pocket. I actually don't remember my TikTok, so you don't have to worry about that. Um Instagram. And look me up on YouTube, uh Paul Kosienski. It's linked on my Instagram. Go to my Instagram. Freaking you better go to my Instagram.

Dr Ben 57:18

At Paula Comedy. Paula Comedy. The Paula, the only Paula in comedy, probably.

Paula Kosienski 57:25

Paula Poundstone.

Dr Mike and Dr Ben 57:27

She's funny. All right. I love it. And Dr. Mike, our healthcare rock star. Anything for our listeners? Do you want patients to find you? Uh, if you're gonna find me, you're usually gonna find me in the emergency department. So hopefully you do not need to ever find me for any one of my specialties. But if you do, I will try to make you laugh if you're not trying to die on me.

Dr Ben 57:50

And are you on any social media that you yeah, actually?

Dr Mike 57:53

Yeah, so Instagram, TikTok, YouTube at ToxDocs. T-O-X-D-O-C-X.

Dr Ben 58:00

Tox Doc. I like it. The TikTok toxdock.

Paula Kosienski 58:07

You can see them on ZocDoc.

Dr Ben 58:09

All right, I'm grateful for you both. Thank you. Sirius Says from the ER Pro, hilarious detox from our comic pro. Together, you two are an antidote, just what we needed. We will see you next week, listener, when I, Dr. Ben, and my friends help you put more med in comedy. See you next week. Take care.

Speaker 2 58:40

Dr. Ben and Friend.