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Toxidromes

Toxidromes. Brad Peckler MD Lincoln Hospital Center Bronx, New York. Diagnostic Odors. Cyanide Isopropanol Placidyl Hemlock Hydrogen sulfide Camphor Phosgene Naphthalene

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Toxidromes

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  1. Toxidromes • Brad Peckler MD • Lincoln Hospital Center • Bronx, New York

  2. Diagnostic Odors • Cyanide Isopropanol • Placidyl Hemlock • Hydrogen sulfide Camphor • Phosgene Naphthalene • Op’s/ Arsenic Hydrocarbons • Methylsalicylate • Chloral hydrate • Zinc phosphate • Paradichlorobenzene

  3. But as the world is harmoniously confused:Where order in variety we see,And where, though all things differ, all agree. Alexander Pope

  4. 69 y/o male with chronic low back pain presents with change in mental status.

  5. 28 y/o woman found in bathroom found unconscious with a syringe on the floor.

  6. Narcotics • Hypoventilation • Pinpoint pupils • Somnolence • ~Hypotension

  7. Narcotics • Meperidine Vagolytic • Serotonin syndrome • Noromeperidine • Propoxyphene Prolonged QT • Mixed agonist/antagonist • Synthetic opiates • Drug combinations

  8. 18 y/o male brought in by NYPD because he’s acting crazy and violent. • HR 144 BP 180/90 RR 22 • Diaphoretic, 8mm pupils

  9. Sympathomimetics • HTN • Tachycardia • Mydriasis • Diaphoresis • CNS excitement

  10. Sympathomimetics • Drugs of abuse • Adrenergic agonists • Amphetamines • Cocaine • PCP • TCA • Early MAOI • Sedative/hypnotic withdrawal

  11. 70 y/o female used a flea bomb in her house and forgot to open the windows before entering the house • C/o eye tearing, SOB, vomiting

  12. Cholinergic crisis • Organophosphates • Organophosphothionates • Carbamates • Insecticides • Nerve agents • 2-PAM

  13. Organophosphates • Acetylcholinesterase • Acetylcholine No hydrolysis • Nervous tissue and RBC • Concentrated in CNS • Parasympathetic nerve endings • Sympathetic nerve endings • Somatic nerves • Autonomic ganglia • Pseudocholinesterase • Liver and serum

  14. Muscarinic Diarrhea Urination Meiosis Bronchospasm/secretions Emesis Lacrimination Salvation/sweating SLUDGE + Bradycardia Nicotinic CNS NMJ Adrenal Ganglia Sweating +Tachycardia +Hypertension

  15. 18 y/o male BIBPD c/o hallucinations and “cotton mouth” • OE: temp 102, distended abdomen

  16. Anticholinergics Sympathomimetics LSD PCP GHB Psilocybin Pentamidine Nutmeg/Mace Functional Organic Migraines Encephalitis Rabies Digoxin/Methanol Alcohol intoxication Alcohol withdrawal Visual Hallucinations

  17. Hallucinations • Olfactory • Migrane, Pre-seizure, Acidosis, FB • Frontal lobe tumor • Sensory • DT’s, Cocaine, Menapause, HCG, Liver dz • Auditory • Functional, ASA, CN VIII

  18. 25 y/o female took some pills • Comatose, dry mucous membrane, tachycardic, had a seizure at home.

  19. Anticholinergics • TCA • Scopolamine/polo • Neuroleptics • Parkinson meds • Benzotropine/trihexphendyl • Jimson weed • Antihistamines Methylqualone • Piperdones Gyromitra

  20. TCA • Anticholinesterase inhibitor • Alpha blocker • Sodium channel blocker (1A) • Amine uptake inhibitor • GABA inhibitor

  21. AnticholinergicvsSympathomimetc • Dry Wet • Absent bowel sounds NL bowel sounds • Psychosis Agitated • Mydriasis Mydriasis • Hyperthermia Hyperthermia • Red Flushed • Tachy/BP ? Tachy/HTN

  22. 60 y/o prisoner with AMS and a suicide note. Had a seizure en route to hospital and has continued to seize for 45 minutes • After ABC’s • FS 402 • 7.22/22/360

  23. Status Epilepticus • INH • Theophylline • Hypoglycemia

  24. Seizure Hyperglycemia Metabolic Acidosis • INH • ASA • DKA • Theophylline • CO/CN • Anticholinergic • Phenytoin

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