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Toxidromes Brad Peckler MD Lincoln Hospital Center Bronx, New York
Diagnostic Odors Cyanide Isopropanol Placidyl Hemlock Hydrogen sulfide Camphor Phosgene Naphthalene Op’s/ Arsenic Hydrocarbons Methylsalicylate Chloral hydrate Zinc phosphate Paradichlorobenzene
But as the world is harmoniously confused: Where order in variety we see, And where, though all things differ, all agree. Alexander Pope
69 y/o male with chronic low back pain presents with change in mental status.
28 y/o woman found in bathroom found unconscious with a syringe on the floor.
Narcotics Hypoventilation Pinpoint pupils Somnolence ~Hypotension
Narcotics MeperidineVagolytic Serotonin syndrome Noromeperidine PropoxypheneProlonged QT Mixed agonist/antagonist Synthetic opiates Drug combinations
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
Sympathomimetics HTN Tachycardia Mydriasis Diaphoresis CNS excitement
Sympathomimetics Drugs of abuse Adrenergic agonists Amphetamines Cocaine PCP TCA Early MAOI Sedative/hypnotic withdrawal
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
Cholinergic crisis Organophosphates Organophosphothionates Carbamates Insecticides Nerve agents 2-PAM
Organophosphates Acetylcholinesterase AcetylcholineNo hydrolysis Nervous tissue and RBC Concentrated in CNS Parasympathetic nerve endings Sympathetic nerve endings Somatic nerves Autonomic ganglia Pseudocholinesterase Liver and serum
Muscarinic Diarrhea Urination Meiosis Bronchospasm/secreti ons Emesis Lacrimination Salvation/sweating SLUDGE + Bradycardia Nicotinic CNS NMJ Adrenal Ganglia Sweating +Tachycardia +Hypertension
18 y/o male BIBPD c/o hallucinations and “cotton mouth” OE: temp 102, distended abdomen
Visual Hallucinations Anticholinergics Sympathomimetics LSD PCP GHB Psilocybin Pentamidine Nutmeg/Mace Functional Organic Migraines Encephalitis Rabies Digoxin/Methanol Alcohol intoxication Alcohol withdrawal
Hallucinations Olfactory Migrane, Pre-seizure, Acidosis, FB Frontal lobe tumor Sensory DT’s, Cocaine, Menapause, HCG, Liver dz Auditory Functional, ASA, CN VIII
25 y/o female took some pills Comatose, dry mucous membrane, tachycardic, had a seizure at home.
Anticholinergics TCA Scopolamine/polo Neuroleptics Parkinson meds Benzotropine/trihexphendyl Jimson weed AntihistaminesMethylqualone PiperdonesGyromitra
TCA Anticholinesterase inhibitor Alpha blocker Sodium channel blocker (1A) Amine uptake inhibitor GABA inhibitor
Anticholinergic vs Sympathomimetc Dry Wet Absent bowel soundsNL bowel sounds PsychosisAgitatedMydriasisHyperthermia RedFlushed Tachy/BP ?Tachy/HTN
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
Status Epilepticus INH Theophylline Hypoglycemia
Seizure Hyperglycemia Metabolic Acidosis INH ASA DKA Theophylline CO/CN Anticholinergic Phenytoin
Toxicology 101 Joshua Rocker, MD Schneider Children’s Hospital.
Toxidromes and Drug Ingestions. Toxidromes What is a Toxidrome? What is a Toxidrome? A constellation of clinical signs that may suggest a particular type.
3 rd Year Toxicology Core Facts: Zohair A. Al Aseri MD, FRCPC EM & CCM Chairman and Assistant Professor, DEM College of Medicine King Saud University Consultant.
Isoniazid Seizure Glutamic acid decarboxylase Coenzyme pyridoxamine No GABA formed AG metabolic acidosis Blocks conversion of lactate to pyruvate Hyperglycemia.
Toxicology Review Christian La Rivière, MD, FRCPC.
Elliot Melendez, MD. Objectives Discuss Principles of Toxin Assessment and Screening Discuss toxidromes and their management Discuss specific toxins.
APPROACH TO TOXICOLOGY Dr Sattam Alenezi. TOXIC overdose can present with a great variety of clinical symptoms from minor presentations such as nausea.
Drug Induced Arrhythmia Dr. SH TSUI 15 June 2005.
Substance Abuse and Poisonings Chapter 17. Identifying the Patient and the Poison Poison- any substance who’s chemical reaction can damage body structures.
Serotonin syndrome: A literature review of therapeutic options? Rob Hall MD, PGY4 FRCPC Emergency Medicine Nov 8, 2003.
Khalid Gabralla, MD Assistant Professor Emergency Medicine King Saud University.
TCA and Serotonin Re-Uptake Inhibitors Rama B. Rao, MD Bellevue/New York University Medical Center.
Antidotal therapy involves antagonism or chemical inactivation of an absorbed poison The pharmacodyamics of a poison can be altered by competition at.
Slide 1 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 13 Drugs Affecting the Autonomic Nervous System.
TOXIDROMES. Searching for Clues HISTORY When to suspect Approach to known exposure Approach to unknown exposure.
Introduction to Toxicology. General toxicology Define what is meant by the science of toxicology. Define what is meant by the science of toxicology. Describe.
NEURONS & NEURAL TRANSMISSION NEUROCHEMICAL MECHANISMS OF DRUG ACTION.
INDIRECT CHOLINOMIMETICS Prof. Hanan Hagar Pharmacology Department.
Lecture 3 Autonomic Nervous System. Chapter 20 Autonomic Nervous System n n Central Nervous System (CNS) - Brain and spinal cord n n Peripheral Nervous.
Cholinergic agonists & Cholinergic antagonists Adrenergic agonists & Adrenergic antagonists.
Sudden onset of unexplained illness in a person with Psychotic illness Family conflicts Economic crisis Occupational exposure H/O alcohol.
Breathing By observation and oximetry (monitor the saturation of pt’s Hb) Ventilatory failure…..most common cause of death in poisoned patients :…………..mechanical.
DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM 10/8/2015Winter
THE APPROACH TO THE POISONED PATIENT Toxicology Skills Workshop Regions Hospital Emergency Medicine Program.
THE AUTONOMIC NERVOUS SYSTEM Chapter 14. Divisions of the Nervous System.
INTOXICATION AFTER INGESTION OF A DELETERIOUS PLANT 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki Medical School of.
: Monoamine hypothesis of depression asserts that depression is caused by functional insufficiency of monoamine neurotransmitter (norepinephrine, serotonin.
Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 28 Toxicology.
Drugs Affecting Peripheral Nervous System #2. Fight or Flight versus the Parasympathetic Pig.
INTRODUCTION TO AUTONOMIC PHARMACOLOGY: Part VI Interaction of drugs with the autonomic nervous system.
The Poisoned Patient Core Clerkship in Emergency Medicine University of Colorado at Denver Health Sciences Center.
Poisoning and Toxicology. 34 year old man presents to the hospital after being found in his apartment. According to NetCare, he has no significant past.
Dr: Samah Gaafar Al-shaygi بسم الله الرحمن الرحيم.
INDIRECT CHOLINOMIMETICS Department of Pharmacology Prof. Alhaider Pharmacology Department Prof. Hanan Hagar Pharmacology Department.
Pediatric Poisoning Edwin de Zoeten M.D. Ph.D. PL-3.
Drug Notes Illegal Drugs I. Psychoactive Drugs Four Main Types 1. Stimulants2. Depressants 3. Narcotics4. Hallucinogen Stimulants ◦ Increase HR, BP - Increase.
Toxins of Terrorism and Mass Aggression Rama B. Rao, MD NYUMC/Bellevue Hospital Center.
What students should know: Classification of indirect acting cholinomimetics Mechanism of action, kinetics, dynamics and uses of anticholinesterases.
DRUGS OF ABUSE NICOTINE. Tobacco Plant Grown for its nicotine containing leaves which are smoked, chewed, or sniffed Nicotiana tobacum.
Diabetes – What is it? Hormone (insulin) needed to regulate blood glucose levels is ineffective; Glucose levels can get too high or too low Type I - patients.
Autonomic Nervous System. Fig General functions Control and Adaptation of body systems to internal and/or external changes.
Chapter 34 The Autonomic Nervous System. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Autonomic.
Cholinergics, anticholinergics and antcholinesterases Nervous System Peripheral NS Sensory nerves Motor nerves Central NS (Brain and Spinal cord) Sensory.
INDIRECT CHOLINOMIMETICS Prof. Alhaider Pharmacology Department Prof. Hanan Hagar Pharmacology Department.
TOXICOLOGY Prof. RNDr. Zdeněk DVOŘÁK, DrSc., Ph.D. Department of Cell Biology Genetics Faculty of Science, Palacky University Olomouc Intoxications:
Autonomic Nervous System ANS Honors Anatomy & Physiology for copying.
Pharmacology DOR 101 Abdelkader Ashour, Ph.D. 5 th Lecture.
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