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==Background==
==Background==
===Autonomic Nervous System===
===Autonomic Nervous System===
# Parasympathetic - ACh is transm
* Parasympathetic - ACh is transm
## Muscarinic
** Muscarinic
###receptors in heart, eye, lung, GI, skin and sweat glands
***receptors in heart, eye, lung, GI, skin and sweat glands
### Bradycardia
*** Bradycardia
### Miosis
*** Miosis
### Bronchorrhea / Bronchospasm
*** Bronchorrhea / Bronchospasm
### Hyperperistalsis (SLUDGE)
*** Hyperperistalsis (SLUDGE)
### Sweating
*** Sweating
### Vasodilation
*** Vasodilation
## Nicotinic
** Nicotinic
### receptors in both sympathetic and parasympathetic nervous systems
*** receptors in both sympathetic and parasympathetic nervous systems
### fasciculations, flaccid paralysis
*** fasciculations, flaccid paralysis
###?Mild bradycardia, hypotension
***?Mild bradycardia, hypotension
# Sympathetic
* Sympathetic
##ALPHA EFFECTS - vessels, eye, skin
**ALPHA EFFECTS - vessels, eye, skin
### Mydriasis, HTN, Sweating
*** Mydriasis, HTN, Sweating
##BETA EFFECTS - heart, lungs
**BETA EFFECTS - heart, lungs
### Tachycardia, Bronchodilation
*** Tachycardia, Bronchodilation


==Diagnosis==
==Diagnosis==
===Toxicological Exam===
===Toxicological Exam===
# All VS (Temp, RR,HR, BP)
* All VS (Temp, RR,HR, BP)
# Neuro Exam
* Neuro Exam
##Level of consciousness
**Level of consciousness
##Pupillary exam
**Pupillary exam
##Motor response
**Motor response
#Skin Exam - moisture, temp
*Skin Exam - moisture, temp
# Lung Exam
* Lung Exam
# Bowel Sounds
* Bowel Sounds


===Toxidrome Chart===
===Toxidrome Chart===
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==Differential Diagnosis for Specific Signs==
==Differential Diagnosis for Specific Signs==
===Hyperthermia===
===Hyperthermia===
#Altered Metabolism
*Altered Metabolism
## [[Aspirin (Salicylate) Toxicity]]
** [[Aspirin (Salicylate) Toxicity]]
## withdrawal states
** withdrawal states
## thyroid hormones
** thyroid hormones
## dinitrophenols
** dinitrophenols
# Increased Muscle Activity
* Increased Muscle Activity
## withdrawal, sympathomimetics
** withdrawal, sympathomimetics
## [[MAOI Toxicity]]
** [[MAOI Toxicity]]
##[[PCP]], LSD
**[[PCP]], LSD
## [[Lithium]]
** [[Lithium]]
## Amoxapine
** Amoxapine
##[[Serotonin Syndrome]]
**[[Serotonin Syndrome]]
# Impaired Heat Dissipation
* Impaired Heat Dissipation
## anticholinergics
** anticholinergics
## antihistamines
** antihistamines
## antipsychotics ([[TCAs]])
** antipsychotics ([[TCAs]])
# [[Malignant Hyperthermia]]
* [[Malignant Hyperthermia]]
## anesthestics
** anesthestics
# [[Neuroleptic Malignant Syndrome]]
* [[Neuroleptic Malignant Syndrome]]
## phenothiazines, [[Lithium]], LevoDopa
** phenothiazines, [[Lithium]], LevoDopa


===Hypothermia===
===Hypothermia===
# Exposure
* Exposure
## [[Ethanol Toxicity]]
** [[Ethanol Toxicity]]
## Sedative hypnotics
** Sedative hypnotics
## Narcotics
** Narcotics
## [[TCAs]]
** [[TCAs]]
## Phenothiazines
** Phenothiazines
## [[Insulin]] ([[Hypoglycemia]])
** [[Insulin]] ([[Hypoglycemia]])


===Increased Respiratory Rate===
===Increased Respiratory Rate===
# Direct Stimulation
* Direct Stimulation
## [[Aspirin (Salicylate) Toxicity]]
** [[Aspirin (Salicylate) Toxicity]]
## [[Metabolic Acidosis]]
** [[Metabolic Acidosis]]
## dintirophenol, pentachlorophenol
** dintirophenol, pentachlorophenol
## hepatorenal failure
** hepatorenal failure
## CNS stimulants (cocaine, amphet, theophylline)
** CNS stimulants (cocaine, amphet, theophylline)
#Tissue [[Hypoxia]]
*Tissue [[Hypoxia]]
##[[CO]]
**[[CO]]
##[[Cyanide]]
**[[Cyanide]]
##[[Hydrogen Sulfide]]
**[[Hydrogen Sulfide]]
##[[Methemoglobinemia]]
**[[Methemoglobinemia]]


===Respiratory Depression===
===Respiratory Depression===
# Central Depression
* Central Depression
## antipsychotics
** antipsychotics
## Chlorinated hydrocarbons
** Chlorinated hydrocarbons
## [[Sedative/Hypnotics]] ([[Ethanol Toxicity]], glycols)
** [[Sedative/Hypnotics]] ([[Ethanol Toxicity]], glycols)
## [[Tricyclic (TCA) Toxicity]]
** [[Tricyclic (TCA) Toxicity]]
## Lomitil
** Lomitil
# Muscle Failure
* Muscle Failure
## [[Organophosphates]]
** [[Organophosphates]]
##[[Marine Toxins]]
**[[Marine Toxins]]
## [[Nicotine Poisoning|Nicotine]]
** [[Nicotine Poisoning|Nicotine]]
## strychnine
** strychnine
## botulinis
** botulinis
## Mojave rattlesnake, Cobra
** Mojave rattlesnake, Cobra


==See Also==
==See Also==
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==Source==
==Source==
Originally adapted from BIRNBAUMER


[[Category:Tox]]
[[Category:Tox]]
[[Category:EMS]]
[[Category:EMS]]

Revision as of 16:08, 12 March 2015

Background

Autonomic Nervous System

  • Parasympathetic - ACh is transm
    • Muscarinic
      • receptors in heart, eye, lung, GI, skin and sweat glands
      • Bradycardia
      • Miosis
      • Bronchorrhea / Bronchospasm
      • Hyperperistalsis (SLUDGE)
      • Sweating
      • Vasodilation
    • Nicotinic
      • receptors in both sympathetic and parasympathetic nervous systems
      • fasciculations, flaccid paralysis
      • ?Mild bradycardia, hypotension
  • Sympathetic
    • ALPHA EFFECTS - vessels, eye, skin
      • Mydriasis, HTN, Sweating
    • BETA EFFECTS - heart, lungs
      • Tachycardia, Bronchodilation

Diagnosis

Toxicological Exam

  • All VS (Temp, RR,HR, BP)
  • Neuro Exam
    • Level of consciousness
    • Pupillary exam
    • Motor response
  • Skin Exam - moisture, temp
  • Lung Exam
  • Bowel Sounds

Toxidrome Chart

Toxidrome Chart

Finding Cholinergic Anticholinergic Sympathomimetic Sympatholytic^ Sedative/Hypnotic
Example Organophosphates TCAs Cocaine Clonidine ETOH
Temp Nl Nl / ↑ Nl / ↑ Nl / ↓ Nl / ↓
RR Variable Nl / ↓ Variable Nl / ↓ Nl / ↓
HR Variable ↑ ↑ (sig) Nl / ↓ Nl / ↓
BP ↑ ↑ ↑ Nl / ↓ Nl / ↓
LOC Nl / Lethargic Nl, agitated, psychotic, comatose Nl, agitated, psychotic Nl, Lethargic, or Comatose Nl, Lethargic, or Comatose
Pupils Variable Mydriatic Mydriatic Nl / Miotic
Motor Fasciculations, Flacid Paralysis  Nl Nl / Agitated Nl
Skin Sweating (sig) Hot, dry Sweating Dry
Lungs Bronchospasm / rhinorrhea Nl Nl Nl
Bowel Sounds Hyperactive (SLUDGE) ↓ / Absent Nl / ↓ Nl / ↓
^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
Withdrawal from substances have the opposite effect
^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan

Differential Diagnosis for Specific Signs

Hyperthermia

Hypothermia

Increased Respiratory Rate

Respiratory Depression

See Also

Source

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