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Overdosed and Poisoned Patients. Toxidromes. Toxidromes. Cholinergic Anticholinesterase Narcotic/Barbituates Anticholinergic Sympathomimetic/Withdrawal. Cholinergic Overdose. Causes: Organophosphate Poisoning Insecticides and Herbicides Nerve Agent Exposure Sarin Gas.
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Overdosed and Poisoned Patients Toxidromes
Toxidromes Cholinergic Anticholinesterase Narcotic/Barbituates Anticholinergic Sympathomimetic/Withdrawal
Cholinergic Overdose • Causes: • Organophosphate Poisoning • Insecticides and Herbicides • Nerve Agent Exposure • Sarin Gas
Cholinergic Overdose • D - Diarrhea • U - Urination • M - Miosis • B - Bronchorrhea • B - Bradycardia • E - Emesis • L - Lacrimation • S - Salivation • S - Salivation • L - Lacrimation • U - Urination • D - Defecation • G – G.I. Cramps • E - Emesis
Cholinergic Overdose Other Signs and Symptoms: Pulmonary edema, hypotension, sweating and bronchoconstriction Later Signs include: Tachycardia, Mydriasis, hypertension, weakness, fasciculations and paralysis CNS may include anxiety, restlessness, seizure, coma, death
Cholinergic Overdose • Treatment: • Consider Paramedic Safety - Exposure • Oxygen, Cardiac Monitor, IV • Rapid Transport • Atropine (ACP, IRU team)
Anticholinergic Overdose • Causes: • Tricyclic Overdose • Antidepressants • Antihistamines • OTC Cold and Sleep Medications • Mushrooms • Atropine • Gravol
Anticholinergic Overdose Red as a beet Blind as a bat Hot as a Hare Dry as a bone Mad as a Hatter
Anticholinergic Overdose • Signs and Symptoms • Dry skin and membranes • Thirst • Urinary retention • Mydriasis • Hyperpyrexia • Flushed skin • Anxiety / Agitation • Confusion • Dysphagia • Delirium • Ataxia • Lethargy • Respiratory Failure
Anticholinergic Overdose • Treatment: • Oxygen, Cardiac Monitor, IV, • Rapid transport • Sodium Bicarbonate, Midazolam (ACP)
Narcotics and Barbituates • Narcotics: • Morphine • Heroin • Codeine • Demerol • Oxycontin • Barbituates: • Phenobarbital • Butabarbital • Secobarbital
Narcotics and Barbituates • Signs and Symptoms: • Miosis (Narcotics except Demerol) • Mydriasis (Barbituates) • Respiratory Depression • Pulmonary Edema • CNS Depression • Hypotension • Seizures
Narcotics and Barbituates • Treatment: • Oxygen, Cardiac Monitor, IV • Transport • Consider ventilatory support / Airway management • Narcan (for Narcotics only)
Sympathomimeticsand Withdrawal • Causes: • Cocaine • Amphetamines • PCP • LSD • Caffeine • Theophylline • Drug Withdrawal
Sympathomimetics and Withdrawal • Signs and Symptoms: • Pallor • Diaphoresis • Tachycardia • Agitation • Nausea/Vomiting
Sympathomimetics and Withdrawal • Treatment: • Oxygen, Cardiac Monitor, IV • Transport • Nitrates for MI • Midazolam (Agitation/Seizures) ACP)
Drugs That Cause Miosis Narcotics (Except Demerol) Anticholinesterases (Organophosphates) Phenicyclidine (PCP) Mushrooms Phenothiazine (tranquilizer)also cause Mydriasis)
Drugs That Cause Mydriasis Anticholinergics Sympathomimetics Drug Withdrawal Barbituates
Drugs That Cause Pulmonary Edema Salicylates (ASA) Narcotics Carbon Monoxide Sedative-Hypnotics (GHB) Organophosphates
Toxidromes • Pinpoint Pupils • CNS Depression • Shallow Breathing • ????????????? Narcotics!
Toxidromes • Dilated Pupils • Dry Skin • Decreased GI motility • Cardiac Arrhythmia’s • ?????????????? Anticholinergic!!
Toxidromes • Pinpoint Pupils • Sweating • Increased Secretions • Increased GI Motility • ?????????????? Cholinergic!!!
Toxidromes • Hyperadrenergic • Diaphoresis • Tachycardia • Agitation • ??????????????? Sympathomimetic!!!