E - Expose and Examine the Patient

Question 1

Name things to examine in patients (5)

Answer 1

• vital signs (including temperature), skin (needle tracks,colour), mucous membranes, pupils, odours, and CNS
• head-to-toe survey including
  
  • C-spine
  • signs of trauma, seizures (incontinence, “tongue biting”, etc.), infection (meningismus), or chronic alcohol/drug misuse (track marks, nasal septum erosion)
  • feel the patient’s axillae; in the average patient, should be somewhat moist (if dry, may indicate anticholinergic toxicity)
• mental status

Question 2

Name specific toxidromes (7)

Answer 2

• Anticholinergic
• Cholinergic
• Extrapyramidal
• Hemoglobin Derangements
• Opioid, Sedative/ Hypnotic, EtOH
• Sympathomimetic
• Serotonin Syndrome

Question 3

Name examples of anticholinergic drugs (8)

Answer 3

• Antidepressants (e.g. TCAs)
• Cyclobenzaprine (Flexeril®)
• Carbamazepine
• Antihistamines (e.g. diphenhydramine)
• Antiparkinsonians
• Antipsychotics
• Antispasmodics
• Belladonna alkaloids (e.g. atropine)

Question 4

Name Overdose Signs and Symptoms: Anticholinergic (6)

Answer 4

• Hyperthermia: “Hot as a hare”
• Dilated pupils: “Blind as a bat”
• Dry skin: “Dry as a bone”
• Vasodilation: “Red as a beet”
• Agitation/hallucinations “Mad as a hatter”
• Ileus/Urinary retention/Tachycardia: “The bowel and bladder lose their tone and the heart goes on alone”

Question 5

Name examples cholinergic drugs (4)

Answer 5

• Natural plants: mushrooms, trumpet flower
• Anticholinesterases: physostigmine
• Insecticides (organophosphates, carbamates)
• Nerve gases

Question 6

Name Overdose Signs and Symptoms: Cholinergic (7)

Answer 6

“DUMBELS”

• Diaphoresis, Diarrhea, Decreased BP
• Urination
• Miosis
• Bronchospasm, Bronchorrhea, Bradycardia
• Emesis, Excitation of skeletal muscle
• Lacrimation
• Salivation, Seizures

Question 7

Name examples of drugs: Extrapyramidal (2)

Answer 7

• Major tranquilizers
• Antipsychotics

Question 8

Name Overdose Signs and Symptoms : Extrapyramidal (5)

Answer 8

• Dysphonia, dysphagia
• Rigidity and tremor
• Motor restlessness, crawling sensation (akathisia)
• Constant movements (dyskinesia)
• Dystonia (muscle spasms, laryngospasm, trismus, oculogyric crisis, torticollis)

Question 9

Name examples of drugs: Hemoglobin Derangements (2)

Answer 9

• CO poisoning (carboxyhemoglobin)
• Drug ingestion (methemoglobin, sulfmethemoglobin)

Question 10

Name Overdose Signs and Symptoms: Hemoglobin Derangements (5)

Answer 10

• Increased respiratory rate
• Decreased LOC
• Seizures
• Cyanosis unresponsive to O2
• Lactic acidosis

Question 11

Name examples of drugs: Opioid, Sedative/ Hypnotic,EtOH (5)

Answer 11

• EtOH
• Benzodiazepines
• Opioids (morphine, heroin, fentanyl, etc.)
• Barbiturates
• GHB (“G,” “liquid gold”)

Question 12

Name Overdose Signs and Symptoms: Opioid, Sedative/ Hypnotic,EtOH (5)

Answer 12

• Hypothermia
• Hypotension
• Respiratory depression
• Dilated or constricted pupils (pinpoint in opioid)
• CNS depression

Question 13

Name examples of drugs: Sympathomimetic (8)

Answer 13

• Amphetamines
• Caffeine
• Cocaine
• LSD
• Phencyclidine
• Ephedrine and other decongestants
• Thyroid hormone
• Sedative or EtOH withdrawal

Question 14

Name Overdose Signs and Symptoms: Sympathomimetic (6)

Answer 14

• Increased temperature
• CNS excitation (including seizures)
• Tachycardia, HTN
• N/V
• Diaphoresis
• Dilated pupils

Question 15

Name examples of drugs: Serotonin Syndrome (6)

Answer 15

• MAOI
• TCA
• SSRI
• Opiate analgesics
• Cough medicine
• Weight reduction medications

Question 16

Name Overdose Signs and Symptoms: Serotonin Syndrome (6)

Answer 16

• Mental status changes
• Autonomic hyperactivity
• Neuromuscular abnormalities
• Hyperthermia
• Diarrhea
• HTN