Toxicology (main): Difference between revisions

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==Diagnosis==
==Diagnosis==
===Toxicological Exam===
===Toxicological Exam===
* All VS (Temp, RR,HR, BP)
* All VS (Temp, RR, HR, BP)
* Neuro Exam
* Neuro Exam
**Level of consciousness
**Level of consciousness
**Pupillary exam
**Pupillary exam
**Motor response
**Motor response
**DTRs
*Skin Exam - moisture, temp
*Skin Exam - moisture, temp
* Lung Exam
* Lung Exam

Revision as of 09:04, 20 June 2015

Background

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
      • ?Mild bradycardia, hypotension
  • Sympathetic
    • ALPHA EFFECTS - vessels, eye, skin
      • Mydriasis, HTN, Sweating
    • BETA EFFECTS - heart, lungs
      • Tachycardia, Bronchodilation

Diagnosis

Toxicological Exam

  • All VS (Temp, RR, HR, BP)
  • Neuro Exam
    • Level of consciousness
    • Pupillary exam
    • Motor response
    • DTRs
  • Skin Exam - moisture, temp
  • Lung Exam
  • Bowel Sounds

Toxidrome Chart

Finding Cholinergic Anticholinergic Sympathomimetic Sympatholytic^ Sedative/Hypnotic
Example Organophosphates TCAs Cocaine Clonidine ETOH
Temp Nl Nl / ↑ Nl / ↑ Nl / ↓ Nl / ↓
RR Variable Nl / ↓ Variable Nl / ↓ Nl / ↓
HR Variable ↑ (sig) Nl / ↓ Nl / ↓
BP Nl / ↓ Nl / ↓
LOC Nl / Lethargic Nl, agitated, psychotic, comatose Nl, agitated, psychotic Nl, Lethargic, or Comatose Nl, Lethargic, or Comatose
Pupils Variable Mydriatic Mydriatic Nl / Miotic
Motor Fasciculations, Flacid Paralysis  Nl Nl / Agitated Nl
Skin Sweating (sig) Hot, dry Sweating Dry
Lungs Bronchospasm / rhinorrhea Nl Nl Nl
Bowel Sounds Hyperactive (SLUDGE) ↓ / Absent Nl / ↓ Nl / ↓
^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
Withdrawal from substances have the opposite effect

Differential Diagnosis for Specific Signs

Hyperthermia

Hypothermia

Increased Respiratory Rate

Respiratory Depression

See Also

Source