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Transcript
Toxidromes
Brad Peckler MD
Lincoln Hospital Center
Bronx, New York
Diagnostic Odors
Cyanide
Placidyl
Hydrogen sulfide
Phosgene
Op’s/ Arsenic
Methylsalicylate
Chloral hydrate
Zinc phosphate
Paradichlorobenzene
Isopropanol
Hemlock
Camphor
Naphthalene
Hydrocarbons
But as the world is
harmoniously confused:
Where order in variety we see,
And where, though all things
differ, all agree.
Alexander Pope
69 y/o male with chronic low
back pain presents with
change in mental status.
28 y/o woman found in
bathroom found
unconscious with a syringe
on the floor.
Narcotics
Hypoventilation
Pinpoint pupils
Somnolence
~Hypotension
Narcotics
Meperidine
Propoxyphene
Vagolytic
Serotonin syndrome
Noromeperidine
Prolonged QT
Mixed agonist/antagonist
Synthetic opiates
Drug combinations
18 y/o male brought in by NYPD
because he’s acting crazy and
violent.
HR 144 BP 180/90 RR 22
Diaphoretic, 8mm pupils
Sympathomimetics
HTN
Tachycardia
Mydriasis
Diaphoresis
CNS excitement
Sympathomimetics
Drugs of abuse
Adrenergic agonists
Amphetamines
Cocaine
PCP
TCA
Early MAOI
Sedative/hypnotic withdrawal
70 y/o female used a flea bomb in her
house and forgot to open the
windows before entering the house
C/o eye tearing, SOB, vomiting
Cholinergic crisis
Organophosphates
Organophosphothionates
Carbamates
Insecticides
Nerve agents
2-PAM
Organophosphates
Acetylcholinesterase
Acetylcholine No hydrolysis
Nervous tissue and RBC
Concentrated in CNS
Parasympathetic nerve endings
Sympathetic nerve endings
Somatic nerves
Autonomic ganglia
Pseudocholinesterase
Liver and serum
Muscarinic
Diarrhea
Urination
Meiosis
Bronchospasm/secreti
ons
Emesis
Lacrimination
Salvation/sweating
SLUDGE
+ Bradycardia
Nicotinic
CNS
NMJ
Adrenal
Ganglia
Sweating
+Tachycardia
+Hypertension
18 y/o male BIBPD c/o
hallucinations and “cotton
mouth”
OE: temp 102, distended abdomen
Visual Hallucinations
Anticholinergics
Sympathomimetics
LSD
PCP
GHB
Psilocybin
Pentamidine
Nutmeg/Mace
Functional
Organic
Migraines
Encephalitis
Rabies
Digoxin/Methanol
Alcohol intoxication
Alcohol withdrawal
Hallucinations
Olfactory
Migrane, Pre-seizure, Acidosis, FB
Frontal lobe tumor
Sensory
DT’s, Cocaine, Menapause, HCG, Liver dz
Auditory
Functional, ASA, CN VIII
25 y/o female took some pills
Comatose, dry mucous membrane,
tachycardic, had a seizure at
home.
Anticholinergics
TCA
Scopolamine/polo
Neuroleptics
Parkinson meds
Benzotropine/trihexphendyl
Jimson weed
Antihistamines
Methylqualone
Piperdones
Gyromitra
TCA
Anticholinesterase inhibitor
Alpha blocker
Sodium channel blocker (1A)
Amine uptake inhibitor
GABA inhibitor
Anticholinergic vs Sympathomimetc
Dry
Absent bowel sounds
Wet
NL bowel sounds
Psychosis
Mydriasis
Hyperthermia
Red
Tachy/BP ?
Agitated
Mydriasis
Hyperthermia
Flushed
Tachy/HTN
60 y/o prisoner with AMS and a
suicide note. Had a seizure en route
to hospital and has continued to seize
for 45 minutes
After ABC’s
FS 402
7.22/22/360
Status Epilepticus
INH
Theophylline
Hypoglycemia
Seizure
Hyperglycemia
Metabolic Acidosis
INH
ASA
DKA
Theophylline
CO/CN
Anticholinergic
Phenytoin