I brought the DantasticTox guys back to discuss how toxidrome really present, you know in real life.

If you missed their first EMCrit episode, go listen:

* EMCrit Podcast 215 - A Disagreement of Toxicologists

and then check out the Dantastic Tox Podcast

by Nick Manzari

Anticholinergic

Altered, but will give you 3 seconds of attention

Big, non-reactive pupils (constrictors knocked out); Pupils may not even be enormous until you stimulate and then they get wide

Dry-everywhere. Put a gloved hand in the axilla if you are brave like Howard

Voice--Worst cottonmouth ever

Picking behaviors (this is the big one) - they will be plucking at EVERYTHING. Taking off gown.

Stimulus evoked tachycardia

Bowel Sounds-screw bowel sounds, because DEMONS

 

Cholinergic

Like Spongebob when you squeeze-water comes from everywhere

“SLUDGE”: Salivation, Lacrimation, Urination, Defecation, GI cramping, Emesis + “Killer B’s”: Bronchorrhea, Bradycardia, Bronchospasm

Pinpoint pupils

Pooping on themselves

Lacrimation

So remember cardiogenic shock with crying and diarrhea and pinpoint pupils.

 

Sympathomimetic

Mydriasis, but briskly reactive (i.e. they will constrict when you shine light)

Sweaty

Psychomotor agitation, Paranoia, Psychotic, but they will respond to questions (but you won't like the answers)

Tachycardia, htn,

BODY TEMPERATURE

Blunts fatigue, pain response, and exhaustion

Sedative/ETOH Withdrawal can only really be differentiated by history

 

Opioid

bradypnea first then look at the pupils

 

Sedative/Hypnotics

Sleepy

Ventilations preserved

Benzo plus is where the problem comes

Now on to the Podcast...