Module 1: Introduction

1.1 Overview of course structure and content

This online course is designed to provide emergency medicine clinicians and poison control specialists with a comprehensive review of risk assessment, antidotal therapy, and advanced management strategies for acetaminophen toxicity. The course consists of 10 modules focused on key aspects of recognizing, evaluating, and treating acetaminophen poisoning in patients.

The learning modules utilize a blend of instructional formats to facilitate retention and application of essential concepts. You will engage with content through video lectures, infographics, case studies, knowledge checks, downloadable algorithms, and point-of-care tools. Upon completion, you will be equipped to expertly care for patients across the full spectrum of acetaminophen toxicity in diverse clinical settings.

Here is an outline of the learning modules:

• Module 1: Introduction
• Module 2: Foundational Knowledge
• Module 3: Clinical Manifestations
• Module 4: Diagnostic Evaluation
• Module 5: Management Principles
• Module 6: Special Considerations
• Module 7: Case Studies
• Module 8: Literature Review
• Module 9: Summary
• Module 10: Knowledge Assessment

This introductory module will provide helpful context on the learning goals, instructional methods, and overall course flow. The remaining modules deliver substantive training on acetaminophen poisoning through a logical learning progression.

---

1.2 Background on acetaminophen toxicity prevalence, morbidity, and mortality

Acetaminophen poisoning is a critical issue in medical toxicology given its widespread use and narrow therapeutic index. In the United States alone, acetaminophen overdose results in over 78,000 emergency department visits annually. It is also the most common pharmaceutical agent implicated in poison control center calls, accounting for 11% of exposures reported to poison control centers in 2021.

Despite FDA efforts to enhance product labeling and limit overdose risk, acetaminophen remains widely accessible in prescription and over-the-counter medications, often in combination formulations. At recommended doses, acetaminophen is a safe and effective analgesic for pain relief and antipyretic for fever reduction. However, excessive single doses or long-term high doses exceeding the maximum recommended daily limits raises the risk of hepatic, renal, and metabolic toxicity.

Acetaminophen hepatotoxicity occurs in a dose-dependent manner through the accumulation of a toxic metabolite, N-acetyl-p-benzoquinoneimine, which depletes glutathione and damages mitochondria in hepatocytes. Fulminant liver failure is associated with high morbidity and mortality if left untreated. Acute liver failure from acetaminophen poisoning has now replaced viral hepatitis as the most common cause of liver failure requiring transplantation in the United States.

Therefore, acetaminophen toxicity represents an important clinical challenge requiring nuanced risk assessment, timely antidote administration, and diligent monitoring. Mastering evidence-based management principles is crucial for emergency providers and poison control specialists seeking to prevent adverse outcomes and save lives.

---

1.3 Relevance to emergency medicine clinicians and poison control specialists

This course offers invaluable training for physicians, pharmacists, nurses, and other healthcare professionals involved in the initial emergency management of patients with suspected acetaminophen poisoning, whether in the emergency department, critical care unit, or poison control call center.

The instructional content is designed to build expertise in:

• Utilizing risk assessment tools such as the Rumack-Matthew nomogram to determine poisoning severity and need for antidotal therapy
• Implementing timely oral or intravenous N-acetylcysteine regimens based on ingestion specifics and clinical presentation
• Recognizing laboratory and physiologic markers of toxicity to guide adjustments in antidote therapy and level of care
• Managing complex overdose scenarios involving massive ingestions, special populations, concomitant disorders, and other variables requiring nuanced approaches
• Monitoring for adverse effects of antidotal therapy and intervening to optimize tolerability and adherence
• Applying the latest evidence-based guidelines and research data to inform patient-centered clinical decision making

The course will equip learners with enhanced knowledge, diagnostic skills, and therapeutic competencies to provide optimal care during this high risk medical emergency. Let’s get started building your expertise!