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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
