When things get exciting: Thoughts on the recent EMCRIT episode on serotonin syndromes.

When things get exciting: Thoughts on the recent EMCRIT episode on serotonin syndromes.

In this emergency medicine toxicology blog, Gregory Yates reflects on a recent EMCRIT podcast episode discussing serotonin syndrome, neuroleptic malignant syndrome, and other hyperthermic drug reactions. The post highlights the diagnostic importance, but potential unreliability, of neuromuscular findings such as clonus, tremor, and hyperreflexia. It also critiques the limitations of relying solely on drug history. The piece underlines the risks of misdiagnosis — and the potential danger of using antipsychotics in the wrong toxidrome. The takeaway: neurological examination can be unrelaible, and clinicians should be cautious when interpreting overlapping toxidromes.

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Sand ambulance

Self-Organised Criticality: Why your ED is like a Sand Pile

Emergency departments (EDs) often seem to shift from calm to crisis in an instant. Why? This article explores ED crowding through the lens of complexity science and self-organised criticality, explaining how minor changes—like a few extra patients—can trigger disproportionate chaos. Using the sandpile analogy and concepts like power law distributions, we reveal why traditional linear models and static targets often fail to manage ED flow effectively. Instead, we offer a data-driven, systems-based approach: identifying tipping points, recognising early warning signs, and implementing proactive, anticipatory interventions. From real-time dashboards to weekly cycle planning and distributed decision-making, this article offers a practical guide for building resilience in emergency care. Learn how your ED can thrive in complexity, not just survive it.

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