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
- Muscarinic
- Sympathetic
- ALPHA EFFECTS - vessels, eye, skin
- Mydriasis, HTN, Sweating
- BETA EFFECTS - heart, lungs
- Tachycardia, Bronchodilation
- ALPHA EFFECTS - vessels, eye, skin
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
- Altered Metabolism
- Aspirin (Salicylate) Toxicity
- withdrawal states
- thyroid hormones
- dinitrophenols
- Increased Muscle Activity
- withdrawal, sympathomimetics
- MAOI Toxicity
- PCP, LSD
- Lithium
- Amoxapine
- Serotonin Syndrome
- Impaired Heat Dissipation
- anticholinergics
- antihistamines
- antipsychotics (TCAs)
- Malignant Hyperthermia
- anesthestics
- Neuroleptic Malignant Syndrome
- phenothiazines, Lithium, LevoDopa
Hypothermia
- Exposure
- Ethanol Toxicity
- Sedative hypnotics
- Narcotics
- TCAs
- Phenothiazines
- Insulin (Hypoglycemia)
Increased Respiratory Rate
- Direct Stimulation
- Aspirin (Salicylate) Toxicity
- Metabolic Acidosis
- dintirophenol, pentachlorophenol
- hepatorenal failure
- CNS stimulants (cocaine, amphet, theophylline)
- Tissue Hypoxia
Respiratory Depression
- Central Depression
- antipsychotics
- Chlorinated hydrocarbons
- Sedative/Hypnotics (Ethanol Toxicity, glycols)
- Tricyclic (TCA) Toxicity
- Lomitil
- Muscle Failure
- Organophosphates
- Marine Toxins
- Nicotine
- strychnine
- botulinis
- Mojave rattlesnake, Cobra