EMCrit Podcast 225 – Tox(&Hound)idromes with Howard & Dan - a podcast by Scott D. Weingart, MD FCCM

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...

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM