Toxicology (main)
Tox Exam
- All VS (Temp, RR,HR, BP)
- Neuro Exam
- Level of consciousness
- Pupillary exam
- Motor response
- Skin Exam - moisture, temp
- Lung Exam
- Bowel Sounds
DDx
Hyperthermia
- Altered Metabolism
- salicylates
- withdrawal states
- thyroid hormones
- dinitrophenols
- Increased Muscle Activity
- withdrawal, sympathomimetics
- MAOI
- PCP, LSD
- lithium, amoxapine
- Impaired Heat Dissipation
- anticholinergics
- antihistamines
- antipsychotics (TCAs)
- Malignant Hyperthermia
- anesthestics
- Neuroleptic Malignant Syndrome
- phenothiazines, Lithium, LevoDopa
Hypothermia
- Exposure
- alcohol, sedative hypnotics
- narcotics, TCAs, phenothiazines
- Insulin (hypoglycemia)
Increased Respiratory Rate
- Direct Stimulation
- salicylates
- metabolic acidosis
- dintirophenol, pentachlorophenol
- hepatorenal failure
- CNS stimulants (cocaine, amphet, theophylline)
Tissue Hypoxia
- CO
- cyanide
- hydrogen sulfide
- methemoglobinemia
Respiratory Depression
- Central Depression
- antipsychotics
- chlorinated hydrocarbons
- alcohols/glycols, sedative/hyp
- TCAs
- Lomitil
- Muscle Failure
- organophosphates
- marine toxins
- nicotine
- strychnine
- botulinis
- Mojave rattlesnake, Cobra
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
- tachycardia, hypertension?
- Muscarinic
- Sympathetic
- ALPHA EFFECTS - vessels, eye, skin
- Mydriasis, HTN, Sweating
- BETA EFFECTS - heart, lungs
- Tachycardia, Bronchodilation
- ALPHA EFFECTS - vessels, eye, skin
Toxidromes
Finding |
Mixed Cholinergic (Organoph) |
Anticholinergic (TCAs, antihist, phenothiazines) |
Sympathomimetic^ (Cocaine, amphet, ecstasy, ketamine) |
Sympatholytic^^ (Clonidine) |
Sedative/Hypnotic |
Temp |
Nl |
Nl/Inc |
Nl/Inc |
Nl/Dec |
Nl/Dec |
RR |
Varriable |
Nl/Dec |
Varriable |
Nl/Dec |
Nl/Dec |
HR |
Varriable |
Inc | Inc (sig) |
Nl/Dec |
Nl/Dec |
BP |
HTN |
Inc |
Inc |
Nl/Dec |
Nl/Dec |
LOC |
Nl/Lethargic |
Nl, agitated, psychotic, comatose |
Nl, agitated, psychotic |
Nl, Lethargic, or Comatose |
Nl, Lethargic, or Comatose |
Pupils |
Varriable |
Mydriatic |
Mydriatic |
Nl/Miotic |
|
Motor |
Facciculations, Flacid Paral |
Nl |
Nl/Agitated |
Nl |
|
Skin |
Sweating (sig) |
Hot, dry |
Sweating |
Dry |
|
Lungs |
Bronchospasm/ rhinorrhea |
Nl |
Nl |
Nl |
|
Bowel Sounds |
Hyperactive (SLUDGE) |
Dec/Absent |
Nl/Dec |
Nl/Dec |
^^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
Source
DONALDSON (Adapted from BIRNBAUMER - 7/18/02)