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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Mar 19, 2018

Want to look cool like a toxicology consultant, sipping coffee on rounds? Ever check a patient for armpit sweat? Learn the secrets of tox from the titans of toxicology podcasting, The Dantastic Mr. Tox & Howard (AKA Dr. Dan Rusyniak and Dr. Howard Greller), as they loquaciously dish on all things tox. Topics include: how to approach the patient with an unknown overdose, are toxidromes clinically useful, clues on physical exam, is GI decontamination still recommended, and why they hate bupropion and tramadol. We recommend cautious ingestion of fluids while listening because this was a seriously funny episode. Try our Self Assessment Questions Toxicology 101 Quiz.

Written and produced by: Christopher Chiu, MD; Graphics by: Beth Garbitelli; Edited by: Matthew Watto, MD

Full show notes available at

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Time Stamps

  • 00:00 Disclosures
  • 00:35 Intro
  • 01:19 Guest bios both real and sarcastic
  • 04:38 Getting to know our guests
  • 06:33 Multiple choice toxicology
  • 09:13 Book recommendations
  • 11:30 Advice for learners and teachers
  • 15:48 Clinical case from Kashlak Memorial Hospital
  • 16:27 Initial approach and some thoughts on toxidromes
  • 21:59 Physical exam, a toxicologist’s approach
  • 27:09 Review of physiology: anticholinergic, cholinergic, sympathomimetic and how to recognize these findings on exam
  • 34:18 Different speech patterns seen in toxicology
  • 35:30 History taking and how much detective work is truly necessary
  • 40:05 The approach to overdose on multiple substances or in setting of polypharmacy
  • 45:52 Seinfeld, ipecac, and the controversy about gastrointestinal decontamination
  • 63:10 Antidotes and when to give them
  • 67:15 EKGs and overdose. Antidote for long QTc versus wide QRS
  • 71:25 Tramadol and Egypt
  • 73:45 Bupropion and bath salts
  • 78:00 Outro

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