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### Tachycardia, Bronchodilation
### Tachycardia, Bronchodilation


== Toxidromes ==
== Toxidromes ==


{| cellspacing="1" cellpadding="1" border="1" width="200"
{| cellspacing="1" cellpadding="1" border="1" width="200"
|-
|-
| Finding<br>
| '''Finding<br>'''
| Mixed Cholinergic (Organoph)<br>
| '''Mixed Cholinergic '''(Organoph)<br>  
| Anticholinergic (TCAs, antihist, phenothiazines) <br>
| '''Anticholinergic '''(TCAs, antihist, phenothiazines)'''<br>'''
| Sympathomimetic^ (Cocaine, amphet, ecstasy, ketamine)<br>
| '''Sympathomimetic'''^ (Cocaine, amphet, ecstasy, ketamine)<br>  
| Sympatholytic^^ (Clonidine)<br>
| '''Sympatholytic'''^^ (Clonidine)<br>  
| Sedative/Hypnotic<br>
| '''Sedative/Hypnotic'''<br>
|-
|-
| Temp<br>
| ''Temp'''''<br>'''
| Nl<br>
| Nl<br>  
| Nl/Inc<br>
| Nl/Inc<br>  
| Nl/Inc<br>
| Nl/Inc<br>  
| Nl/Dec<br>
| Nl/Dec<br>  
| Nl/Dec<br>
| Nl/Dec<br>
|-
|-
| RR<br>
| ''RR''<br>  
| Varriable<br>
| Varriable<br>  
| Nl/Dec<br>
| Nl/Dec<br>  
| Varriable<br>
| Varriable<br>  
| Nl/Dec<br>
| Nl/Dec<br>  
| Nl/Dec<br>
| Nl/Dec<br>
|-
|-
| HR<br>
| ''HR''<br>  
| Varriable<br>
| Varriable<br>  
| Tachy<br>
| Tachy<br>  
| Inc<br>
| Inc<br>  
| Nl/Dec<br>
| Nl/Dec<br>  
| Nl/Dec<br>
| Nl/Dec<br>
|-
|-
| BP<br>
| ''BP''<br>  
| HTN<br>
| HTN<br>  
| <br>
| <br>  
| Inc<br>
| Inc<br>  
| Nl/Dec<br>
| Nl/Dec<br>  
| Nl/Dec<br>
| Nl/Dec<br>
|-
|-
| LOC<br>
| ''LOC''<br>  
| <br>
| Nl/Lethargic<br>  
| Nl, delirious, agitated, psychotic, comatose<br>
| Nl, agitated, psychotic, comatose<br>  
| Nl, agitated, del or psycho <br>
| Nl, agitated, psychotic <br>  
| Nl, Lethargic, or Comatose <br>
| Nl, Lethargic, or Comatose <br>  
| Nl, Lethargic, or Comatose <br>
| Nl, Lethargic, or Comatose <br>
|-
|-
| Pupils<br>
| ''Pupils''<br>  
| Varriable<br>
| Varriable<br>  
| Mydriasis<br>
| Mydriatic<br>  
| Mydriatic<br>
| Mydriatic<br>  
| Nl/Miotic <br>
| Nl/Miotic <br>  
| <br>
| <br>
|-
|-
| Motor<br>
| ''Motor''<br>  
| Facciculations, Flacid Paral <br>
| Facciculations, Flacid Paral <br>  
| Nl<br>
| Nl<br>  
| Nl/Agitated<br>
| Nl/Agitated<br>  
| Nl<br>
| Nl<br>  
| <br>
| <br>
|-
|-
| Skin<br>
| ''Skin''<br>  
| Sweating (sig)<br>
| Sweating (sig)<br>  
| Hot, dry<br>
| Hot, dry<br>  
| Sweating<br>
| Sweating<br>  
| Dry<br>
| Dry<br>  
| <br>
| <br>
|-
|-
| Lungs<br>
| ''Lungs''<br>  
| Bronchospasm/ rhinorrhea <br>
| Bronchospasm/ rhinorrhea <br>  
| Nl<br>
| Nl<br>  
| Nl<br>
| Nl<br>  
| Nl<br>
| Nl<br>  
| <br>
| <br>
|-
|-
| Bowel Sounds<br>
| ''Bowel Sounds''<br>  
| Hyperactive (SLUDGE) <br>
| Hyperactive (SLUDGE) <br>  
| Dec/Absent<br>
| Dec/Absent<br>  
| Nl/Dec<br>
| Nl/Dec<br>  
| Nl/Dec<br>
| Nl/Dec<br>  
| <br>
| <br>
|}
|}
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===  ===
===  ===


^usually more tachy and higher BP than anticholinergic and not dry as in anticholinergic.<br>
^usually more tachy and higher BP than anticholinergic and not dry as in anticholinergic.<br>  


^^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
^^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan

Revision as of 04:54, 17 July 2011

Exam

  1. All VS (Temp, RR,HR, BP)
  2. Neuro Exam
    1. Level of consciousness
    2. Pupillary exam
    3. Motor response
  3. Skin Exam - moisture, temp
  4. Lung Exam
  5. Bowel Sounds

DDx

Hyperthermia

  1. Altered Metabolism
    1. salicylates
    2. withdrawal states
    3. thyroid hormones
    4. dinitrophenols
  2. Increased Muscle Activity
    1. withdrawal, sympathomimetics
    2. MAOI
    3. PCP, LSD
    4. lithium, amoxapine
  3. Impaired Heat Dissipation
    1. anticholinergics
    2. antihistamines
    3. antipsychotics (TCAs)
  4. Malignant Hyperthermia
    1. anesthestics
  5. Neuroleptic Malignant Syndrome
    1. phenothiazines, Lithium, LevoDopa

Hypothermia

  1. Exposure
    1. alcohol, sedative hypnotics
    2. narcotics, TCAs, phenothiazines
    3. Insulin (hypoglycemia)

Increased Respiratory Rate

  1. Direct Stimulation
    1. salicylates
    2. metabolic acidosis
    3. dintirophenol, pentachlorophenol
    4. hepatorenal failure
    5. CNS stimulants (cocaine, amphet, theophylline)

Tissue Hypoxia

  1. CO
  2. cyanide
  3. hydrogen sulfide
  4. methemoglobinemia

Respiratory Depression

  1. Central Depression
    1. antipsychotics
    2. chlorinated hydrocarbons
    3. alcohols/glycols, sedative/hyp
    4. TCAs
    5. Lomitil
  2. Muscle Failure
    1. organophosphates
    2. marine toxins
    3. nicotine
    4. strychnine
    5. botulinis
    6. Mojave rattlesnake, Cobra

Autonomic Nervous System

  1. Parasympathetic - ACh is transm
    1. Muscarinic
      1. receptors in heart, eye, lung, GI, skin and sweat glands
      2. Bradycardia
      3. Miosis
      4. Bronchorrhea / Bronchospasm
      5. Hyperperistalsis (SLUDGE)
      6. Sweating
      7. Vasodilation
    2. Nicotinic
      1. receptors in both sympathetic and parasympathetic nervous systems
      2. fasciculations, flaccid paralysis
      3. tachycardia, hypertension?
  2. Sympathetic
    1. ALPHA EFFECTS - vessels, eye, skin
      1. Mydriasis, HTN, Sweating
    2. BETA EFFECTS - heart, lungs
      1. Tachycardia, Bronchodilation

Toxidromes

Finding
 		Mixed Cholinergic (Organoph)
 Anticholinergic (TCAs, antihist, phenothiazines)
 		Sympathomimetic^ (Cocaine, amphet, ecstasy, ketamine)
 Sympatholytic^^ (Clonidine)
 Sedative/Hypnotic
Temp
 		Nl
 Nl/Inc
 Nl/Inc
 Nl/Dec
 Nl/Dec
RR
 Varriable
 Nl/Dec
 Varriable
 Nl/Dec
 Nl/Dec
HR
 Varriable
 Tachy
 Inc
 Nl/Dec
 Nl/Dec
BP
 HTN
Inc
 Nl/Dec
 Nl/Dec
LOC
 Nl/Lethargic
 Nl, agitated, psychotic, comatose
 Nl, agitated, psychotic
Nl, Lethargic, or Comatose
Nl, Lethargic, or Comatose
Pupils
 Varriable
 Mydriatic
 Mydriatic
 Nl/Miotic

Motor
 Facciculations, Flacid Paral
Nl
 Nl/Agitated
 Nl
Skin
 Sweating (sig)
 Hot, dry
 Sweating
 Dry
Lungs
 Bronchospasm/ rhinorrhea
Nl
 Nl
 Nl
Bowel Sounds
 Hyperactive (SLUDGE)
Dec/Absent
 Nl/Dec
 Nl/Dec

^usually more tachy and higher BP than anticholinergic and not dry as in anticholinergic.

^^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan

Source

DONALDSON (Adapted from BIRNBAUMER - 7/18/02)

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