Toxicologic Emergencies Lecture Powerpoint Flashcards
Toxidromes
Signs and symptoms associated with a specific class of poisoning in a patient (anticholinergic, cholinergic, sympathomimeetic, sedative, serotonergic)
Coma coctail
Used for patient with altered consciousness and includes
- dextrose (hypoglycemia)
- thiamine
- naloxone
Toxidrome approach
- pupil size
- temp
- bowel sounds
- heart rate
- blood pressure
- respiratory rate
- skin findings
Common anticholinergic toxidromes (5)
- antihistamines (diphenyhdramine, hydroxyzine)
- antispasmotics (dicyclomine, oxybutynin)
- atropine
- TCAs (amitriptyline)
- Jimson weed
Anticholinergic toxidrome findings
- hyperthermic, tachycardia, hypertensive
- CNS agitation and delirium
- mydriasis**
- skin dry, warm flushed**
- diminished bowel sounds, urinary retention
Common cholinergic toxidromes (3)
- organophosphates and insectisides
- cholinesterase inhibitors
- nerve agents
Cholinergic toxidrome findings
- bradycardia, high or low BP, high or low breathing
- CNS agitation and confusion
- pinpoint pupils, lacrimation
- diaphoresis***
- salivation, vomiting, diarrhea, incontinence***
Common sympathomimetic toxidromes (5)
- cocaine
- PCP
- amphetamines
- LSD
- bath salts
Sympathomimetic toxidrome findings
- Hyperthermia, tachycardia, hypertension
- CNS enhanced alertness, delirium, seizure, coma
- Mydriatic pupils
- diaphoretic, hot skin
- normal or active bowel sounds
Common opioid toxidromes (6)
- opium
- morphine
- heroin
- hydrocodone (vicodin)
- oxycodone
- fentanyl
Opioid toxidrome findings
- hypothermia, bradycardia, normal or low BP, bradypnea
- CNS lethargy and coma
- pupil miosis
- skin cool, pale, moist, evidence of needle injections
- hypoactive bowel sounds, constipation***
- hyporeflexia on neurologic exam
Common sedative hypnotic toxidromes (4)
- alcohol
- benzos
- barbituates
- sleeping aids
Sedative hypnotic toxidromes findings
- hypothermia, normal or bradycardia
- CNS drowsy, lethargy, coma
- pupils miotic
- decreased or no bowel sounds
- dry
Sympatholytic toxidrome findings
- bradycardia, hypotension, bradypnea
- CNS normal to lethargic
- pupils mid size
Common serotonin syndrome toxidromes (3)
- MAOIs
- SSRIs
- NSRIs
Serotonin syndrome toxidrome findings
- hyperthermia, tachycardia, hypertension
- CNS confusion, agitation, lethargy
- pupils mydriatic
- diaphoretic flushed skin
- hyperreflexia, tremors, clonus
Common sympatholytic toxidromes (3)
- B blockers
- a blockers
- a2 adrenergic agonists
Acetaminophen toxicity antidote
N acetylcysteine
Anticholinergic agents toxicity antidote
Physostigmine
Benzodiazepine toxicity antidote
Flumazenil
Carbon monoxide toxicity antidote
Oxygen
B or Ca2+ channel blockers toxicity antidote
IV fluids, calcium, glucagon, insulin
Cocaine or other sympathomimetics toxicity antidotes
Benzodiazepines
Ethylene glycol (antifreeze) toxicity antidotes
-fomepizole, ethanol, hemodialysis