Toxidrome's

Question 1

What is a toxidrome?

Answer 1

Signs and symptoms associated with a specific toxin

Question 2

Which drug groups are associated with miosis?

Answer 2

Opiates

Cholinergic drugs e.g. organophosphates

Question 3

Which drug groups are associated with mydriasis (dilated pupils)?

Answer 3

Sympathomimetic drugs e.g. cocaine, amphetamines

Anticholinergic drugs e.g. tricyclic antidepressants, antihistamines, atropine, antipsychotics (first generation)

Question 4

What may you be looking for when exposing a suspected poisoned patient?

Answer 4

Medic alert bracelet

IV marks, sores around the mouth from chemical inhalation, burns from caustic substances,

Drug paraphernalia

Signs of self harm, suicide note

Question 5

How should you manage a poisoned patient who is vomiting?

Answer 5

Recovery position and suction.

Suction unit can be set up in advance vomiting is likely

Question 6

When should poisoning be suspected?

Answer 6

Altered conscious level
Symptoms atypical of age group
Context fitting e.g. nightclub
Patient is reluctant to provide information
Bizarre presentation

Question 7

What are the key

a) metabolic
b) traumatic
c) neurological

differential diagnoses of poisoning

Answer 7

Metabolic
Electrolyte imbalance
Hypoxia
Hypoglycaemia

Traumatic
Head injury
Hypotension and haemorrhage

Neurological
Stroke
SAH
Post-ictal state

Question 8

Which drug groups would you suspect in a patient with tachycardia, hypertension and tachypnoea?

Answer 8

Sympathomimetic- Cocaine, amphetamines

Anticholinergics- TCAs, sleeping pills, antihistamines

Question 9

Which drug groups would you suspect in a patient with bradycardia, hypotension and bradypnea ?

Answer 9

Sedatives/hypnotics- BDZs
Opiates- Heroin, codeine
Cholinergic- Organophosphates, mushrooms

Question 10

Describe the clinical features of a patient overdosed on their tricyclic antidepressants

Answer 10

Anticholinergic

RED as a beet- flushed from peripheral vasodilation
HOT as a hare- fever
DRY as a bone- dry skin, mouth
FULL as a flask- urinary retention
MAD as a hatter- hallucinations, confusion

Plus tachycardia, lethargy, coma, FITS, ataxia, dilated pupils.

Question 11

Describe the typical signs and symptoms of a patient who has overdosed on pesticide

Answer 11

Cholinergic

Salivation
Lacrimation
Urinary incontinence 
Defeacation 
Gastric emesis 
E

Bradycardia
Bronchospasm
Bronchorrhea

Question 12

What would be the typical vital signs of a morphine overdose?

Answer 12

Shallow breath sounds
Bradycardia
Hypotension
Hypothermia

Question 13

Examples of Anticholinergic drugs?

Answer 13

AAAAA

Atropine
Antihistamines, 
Antipsychotics,
Anti-Parkinsons drugs 
Anti-depressants

Question 14

How would you manage a suspected anticholinergic overdose?

Answer 14

A-> E

Treat fever

Main risks: fits and/or arrhythmias-> cardiac arrest.

Maintain cardiac monitoring
and transfer to hospital

Fits are normally transient and dysrhythmias don’t normally need treatment (unless VT->lignocaine)

Question 15

Examples of sedative/hypnotic drugs

Answer 15

BDZ- Nitrazepam, loprazolam, temazepam, diazepam

Barbiturates (rare) e.g. phenobarbitone

Question 16

What are the clinical features of sedative overdose?

Answer 16

CNS depression which can vary from drowsiness to coma
Respiratory depression
Confusion/delrium
Ataxia 
Dysarthria 

(like a very drunk person)

Question 17

How should sedative overdose be managed?

Answer 17

Supportive maintaining open airway

Do not give flumazenil (now not recommend as can cause seizures)

Question 18

What is the pharmacology of amphetamines?

Answer 18

Amphetamines are sympathomimetics which means they stimulate the sympathetic nervous system. They do this by blocking the reuptakes of catecholamines, dopamine and serotonin.

Question 19

When do the clinical features of amphetamines present?

Answer 19

normally 1 hour after ingestion

Question 20

What are the clinical features of amphetamine ingestion?

Answer 20

Sympathomimetic effects 
Tachycardia and cardiac arrhythmia
Dilated pupils and blurred vision
Excessive sweating
Hypertension (can result in a CVA) 
Pallor, dry mouth 

Central effects
Agitation, talkative,
paranoia, visual hallucinations
Drowsiness, convulsions- severe poistoning

Hyperpyrexial syndrome can develop

Question 21

How should hyperthermia be managed in an amphetamine patient?

Answer 21

Damp sponging, cold IV fluids if transfer is going to be delayed

Question 22

When might you consider giving an amphetamine patient diazepam?

Answer 22

Fitting/psychotic/agitated

Question 23

What are the clinical features of cocaine overdose?

a) mental status
b) physical exam
c) vital signs

Answer 23

Clinical features are more rapid with inhaled vs. smoked cocaine

Mental status
in mild-moderate intoxication
restless/euphoric/agitated/aggressive/distracted w/hallucinations

severe intoxication
drowsiness/coma

Physical exam
mild/moderate
Slurred speech, ataxia, tremor, pallor, cold sweats, pupillary dilation

severe
hyperreflexia, convulsions, incontinence
Pneumothorax may occur due to repeated valsalva manoeuvre to increase the absorption of inhaled cocaine.

Vital signs
mild-moderate- tachycardia, hypertension, tachypnea, arrhythmia
severe- hyperthermia

Question 24

Why is cocaine life-threatening?

Answer 24

Circulatory and respiratory failure- hypotension, hypoxia, arrhythmias
Severe HTN- stroke, ICH
Artery spasm- myocardial and intestinal ischaemia and acute mesenteric ischaemia.
Hyperthermia

Question 25

What are some of the clinical features associated with overdose of GHB?

Answer 25

Drowsiness, confusion, coma
Nausea, diarrhoea
Vertigo, tremor, extrapyramidal signs
Bradycardia, hypotension, cardiorespiratory depression (severe poisoning)
fits

Question 26

Immediate management for GHB overdose?

Answer 26

A-E
Atropine for bradycardia
Diazemuls for fits