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==DDx==
==DDx==
===Hyperthermia===
===Hyperthermia===
1) Altered Metabolism
#Altered Metabolism
 
## salicylates
- salicylates
## withdrawal states
 
## thyroid hormones
- withdrawal states
## dinitrophenols
 
# Increased Muscle Activity
- thyroid hormones
## withdrawal, sympathomimetics
 
## MAOI
- dinitrophenols
##PCP, LSD
 
## lithium, amoxapine
2) Increased Muscle Activity
# Impaired Heat Dissipation
 
## anticholinergics
- withdrawal, sympathomimetics
## antihistamines
 
## antipsychotics (TCAs)
- MAOI
# Malignant Hyperthermia
 
## anesthestics
-PCP, LSD
# Neuroleptic Malignant Syndrome
 
## phenothiazines, Lithium, LevoDopa
- lithium, amoxapine
 
3) Impaired Heat Dissipation
 
- anticholinergics
 
- antihistamines
 
- antipsychotics (TCAs)
 
4) Malignant Hyperthermia
 
- anesthestics
 
5) Neuroleptic Malignant Syndrome
 
- phenothiazines, Lithium, LevoDopa


===Hypothermia===
===Hypothermia===
1) Exposure
# Exposure
 
## alcohol, sedative hypnotics
- alcohol, sedative hypnotics
## narcotics, TCAs, phenothiazines
 
## Insulin (hypoglycemia)
- narcotics, TCAs, phenothiazines
 
- Insulin (hypoglycemia)


===Increased Respiratory Rate===
===Increased Respiratory Rate===
1) Direct Stimulation
# Direct Stimulation
 
## salicylates
- salicylates
## metabolic acidosis
 
## dintirophenol, pentachlorophenol
- metabolic acidosis
## hepatorenal failure
 
## CNS stimulants (cocaine, amphet, theophylline)
- dintirophenol, pentachlorophenol
 
- hepatorenal failure
 
- CNS stimulants (cocaine, amphet,
 
theophylline)


===Tissue Hypoxia===
===Tissue Hypoxia===
- CO
# CO
 
# cyanide
- cyanide
#hydrogen sulfide
 
# methemoglobinemia
-hydrogen sulfide
 
- methemoglobinemia


===Respiratory Depression===
===Respiratory Depression===
1) Central Depression
# Central Depression
 
## antipsychotics
- antipsychotics
##chlorinated hydrocarbons
 
## alcohols/glycols, sedative/hyp
- chlorinated hydrocarbons
## TCAs
 
## Lomitil
- alcohols/glycols, sedative/hyp
# Muscle Failure
 
## organophosphates
- TCAs
##marine toxins
 
## nicotine
- Lomitil
## strychnine
 
## botulinis
2) Muscle Failure
## Mojave rattlesnake, Cobra
 
- organophosphates
 
- marine toxins
 
- nicotine
 
- strychnine
 
- botulinis
 
- Mojave rattlesnake, Cobra


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


==Toxidromes==
==Toxidromes==

Revision as of 05:47, 13 June 2011

Exam

  1. All VS (Temp, RR,HR, BP)
  2. Neuro Exam
    1. Level of consciousness
    2. Pupillary exam
    3. Motor response
  3. Skin Exam - moisture, temp
  4. Lung Exam
  5. Bowel Sounds

DDx

Hyperthermia

  1. Altered Metabolism
    1. salicylates
    2. withdrawal states
    3. thyroid hormones
    4. dinitrophenols
  2. Increased Muscle Activity
    1. withdrawal, sympathomimetics
    2. MAOI
    3. PCP, LSD
    4. lithium, amoxapine
  3. Impaired Heat Dissipation
    1. anticholinergics
    2. antihistamines
    3. antipsychotics (TCAs)
  4. Malignant Hyperthermia
    1. anesthestics
  5. Neuroleptic Malignant Syndrome
    1. phenothiazines, Lithium, LevoDopa

Hypothermia

  1. Exposure
    1. alcohol, sedative hypnotics
    2. narcotics, TCAs, phenothiazines
    3. Insulin (hypoglycemia)

Increased Respiratory Rate

  1. Direct Stimulation
    1. salicylates
    2. metabolic acidosis
    3. dintirophenol, pentachlorophenol
    4. hepatorenal failure
    5. CNS stimulants (cocaine, amphet, theophylline)

Tissue Hypoxia

  1. CO
  2. cyanide
  3. hydrogen sulfide
  4. methemoglobinemia

Respiratory Depression

  1. Central Depression
    1. antipsychotics
    2. chlorinated hydrocarbons
    3. alcohols/glycols, sedative/hyp
    4. TCAs
    5. Lomitil
  2. Muscle Failure
    1. organophosphates
    2. marine toxins
    3. nicotine
    4. strychnine
    5. botulinis
    6. Mojave rattlesnake, Cobra

Autonomic Nervous System

  1. Parasympathetic - ACh is transm
    1. Muscarinic
      1. receptors in heart, eye, lung, GI, skin and sweat glands
      2. Bradycardia
      3. Miosis
      4. Bronchorrhea / Bronchospasm
      5. Hyperperistalsis (SLUDGE)
      6. Sweating
      7. Vasodilation
    2. Nicotinic
      1. receptors in both sympathetic and parasympathetic nervous systems
      2. fasciculations, flaccid paralysis
      3. tachycardia, hypertension?
  2. Sympathetic
    1. ALPHA EFFECTS - vessels, eye, skin
      1. Mydriasis, HTN, Sweating
    2. BETA EFFECTS - heart, lungs
      1. Tachycardia, Bronchodilation

Toxidromes

Mixed Cholinergic (Organoph)

Temp Normal

RR Increased (spasm -M

inc secretions)

Decreased (N- paralysis)

HR Tachycardia (N-pregang

or Normal or Brady (M)

BP HTN (N)

LOC Normal to Lethargic

Pupils Miotic (M) or Nl or Mydr (N)

Motor Facciculations, Flacid Paral

Skin Sweating (mod to marked

Lungs Bronchospasm/ rrhea

BSs Hyperactive (SLUDGE)

Anticholinergic

(TCAs, antihist, phenothiazines)

Temp Nl to Inc (dec sweating)

RR Nl to Dec

HR Tachy (unopposed B1)

LOC Nl or delirious, agitated,

psychotic, comatose

Pupils Mydriasis (unoppos alpha)

Motor Nl

Skin Dry, hot

Lungs Nl

BSs Decr to Absent

Sympathomimetic

(Cocaine, amphet, ecstasy, ketamine

Temp Nl to Inc (muscle activ inc)

RR Inc or Dec

HR Inc (Beta 1)

BP Inc (alpha 1)

LOC Nl, agitated, del or psycho

Pupils Mydriatic (alpha 1)

Motor Nl to Agitated

Skin Sweating

Lungs Nl

BSs Nl to Dec

- usually more tachy and higher BP than anticholinergic and not dry as in anticholinergic.

- Dexatrim or Ephedrine - alpha stim, can give phentolamine or Nipride

Sympatholytic (Clonidine)

Temp Nl to Dec

RR Nl to Dec

HR, BP Nl to Dec

LOC Nl, Lethargic, or Comatose

Pupils Nl to Miotic

Motor Nl

Skin Dry

Lungs Nl

BSs Nl to Dec

- Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan.

Sedative/Hypnotic

Temp Nl to Dec

RR, HR Nl to Dec All Nl

LOC Nl to Leth

Source

DONALDSON (Adapted from BIRNBAUMER - 7/18/02)

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