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Overdosed and Poisoned Patients

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.

june
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Overdosed and Poisoned Patients

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  1. Overdosed and Poisoned Patients Toxidromes

  2. Toxidromes Cholinergic Anticholinesterase Narcotic/Barbituates Anticholinergic Sympathomimetic/Withdrawal

  3. Cholinergic Overdose • Causes: • Organophosphate Poisoning • Insecticides and Herbicides • Nerve Agent Exposure • Sarin Gas

  4. 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

  5. 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

  6. Cholinergic Overdose • Treatment: • Consider Paramedic Safety - Exposure • Oxygen, Cardiac Monitor, IV • Rapid Transport • Atropine (ACP, IRU team)

  7. Anticholinergic Overdose

  8. Anticholinergic Overdose

  9. Anticholinergic Overdose • Causes: • Tricyclic Overdose • Antidepressants • Antihistamines • OTC Cold and Sleep Medications • Mushrooms • Atropine • Gravol

  10. Anticholinergic Overdose Red as a beet Blind as a bat Hot as a Hare Dry as a bone Mad as a Hatter

  11. 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

  12. Anticholinergic Overdose • Treatment: • Oxygen, Cardiac Monitor, IV, • Rapid transport • Sodium Bicarbonate, Midazolam (ACP)

  13. Narcotics and Barbituates • Narcotics: • Morphine • Heroin • Codeine • Demerol • Oxycontin • Barbituates: • Phenobarbital • Butabarbital • Secobarbital

  14. Narcotics and Barbituates • Signs and Symptoms: • Miosis (Narcotics except Demerol) • Mydriasis (Barbituates) • Respiratory Depression • Pulmonary Edema • CNS Depression • Hypotension • Seizures

  15. Narcotics and Barbituates • Treatment: • Oxygen, Cardiac Monitor, IV • Transport • Consider ventilatory support / Airway management • Narcan (for Narcotics only)

  16. Sympathomimetics and Withdrawal

  17. Sympathomimeticsand Withdrawal • Causes: • Cocaine • Amphetamines • PCP • LSD • Caffeine • Theophylline • Drug Withdrawal

  18. Sympathomimetics and Withdrawal • Signs and Symptoms: • Pallor • Diaphoresis • Tachycardia • Agitation • Nausea/Vomiting

  19. Sympathomimetics and Withdrawal • Treatment: • Oxygen, Cardiac Monitor, IV • Transport • Nitrates for MI • Midazolam (Agitation/Seizures) ACP)

  20. Drugs That Cause Miosis Narcotics (Except Demerol) Anticholinesterases (Organophosphates) Phenicyclidine (PCP) Mushrooms Phenothiazine (tranquilizer)also cause Mydriasis)

  21. Drugs That Cause Mydriasis Anticholinergics Sympathomimetics Drug Withdrawal Barbituates

  22. Drugs That Cause Pulmonary Edema Salicylates (ASA) Narcotics Carbon Monoxide Sedative-Hypnotics (GHB) Organophosphates

  23. Toxidromes • Pinpoint Pupils • CNS Depression • Shallow Breathing • ????????????? Narcotics!

  24. Toxidromes • Dilated Pupils • Dry Skin • Decreased GI motility • Cardiac Arrhythmia’s • ?????????????? Anticholinergic!!

  25. Toxidromes • Pinpoint Pupils • Sweating • Increased Secretions • Increased GI Motility • ?????????????? Cholinergic!!!

  26. Toxidromes • Hyperadrenergic • Diaphoresis • Tachycardia • Agitation • ??????????????? Sympathomimetic!!!

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