Toxidromes

Question 1

What is the first step in the initial stabilization of a patient with a toxidrome?

Answer 1

Airway

Ensuring the airway is clear is crucial for patient survival.

Question 2

Which vital signs are assessed in a toxicological physical examination?

Answer 2

Vital signs, Eyes (pupils), Skin/mucous membranes, Secretions, Mental status

These assessments help identify the effects of toxins on the body.

Question 3

What is the primary basis for the toxidromic approach?

Answer 3

Effects on autonomic nervous system

Understanding the autonomic effects helps categorize the type of toxidrome.

Question 4

What are the vital sign changes in sympathomimetic toxidrome?

Answer 4

Increased heart rate, BP, respiratory rate, and temp

Sympathomimetics stimulate the sympathetic nervous system.

Question 5

Which mental status change is common in sympathomimetic toxidrome?

Answer 5

Agitated

Patients often exhibit increased restlessness and anxiety.

Question 6

Name two common sympathomimetics.

Answer 6

• Topical decongestants (e.g. oxymetazoline, phenylephrine)
• Cocaine

These substances can lead to sympathomimetic effects.

Question 7

What are the signs of anticholinergic toxidrome?

Answer 7

Increased heart rate, BP, dilated pupils, dry skin, dry secretions, agitated mental status

Anticholinergic effects inhibit the parasympathetic nervous system.

Question 8

Which common substances have anticholinergic effects?

Answer 8

• Atropine
• Antipsychotic agents
• Antihistamines (e.g. diphenhydramine)
• Tricyclic antidepressants
• Antispasmodics (e.g. dicyclomine)

Understanding these substances can help in diagnosis.

Question 9

What are the vital sign changes in cholinergic toxidrome?

Answer 9

Decreased heart rate, BP, respiratory rate; constricted pupils; diaphoretic skin; copious secretions; agitated or depressed mental status

Cholinergic effects result from overstimulation of the parasympathetic nervous system.

Question 10

What does the mnemonic ‘Killer B’s’ refer to in cholinergic toxidrome?

Answer 10

Bradycardia, Bronchorrhoea, Bronchospasm

This mnemonic helps remember the key symptoms of cholinergic toxicity.

Question 11

What are common sources of organophosphate and carbamate pesticides?

Answer 11

Often sold illegally as rat poison

These substances are frequently involved in poisoning cases.

Question 12

What are the minimal autonomic effects associated with sedative/hypnotic toxidrome?

Answer 12

Sedation, loss of protective airway reflexes, respiratory depression

These effects can be life-threatening in severe cases.

Question 13

What vital signs are decreased in opioid toxidrome?

Answer 13

Heart rate, BP, respiratory rate, temp

Opioids depress the central nervous system, leading to these changes.

Question 14

What is a key sign of opioid withdrawal toxidrome?

Answer 14

Dilated pupils, increased bowel sounds

Withdrawal symptoms can vary based on the opioid’s duration of action.

Question 15

What are the stages of sedative-hypnotic withdrawal toxidrome?

Answer 15

• Mild withdrawal (6-12 hours)
• Alcohol hallucinosis (12-24 hours)
• Withdrawal seizures
• Withdrawal delirium (DT’s) (72-96 hours)

Recognizing these stages is important for management.

Question 16

What is the conclusion regarding the toxidromic approach?

Answer 16

Narrow the differential diagnosis

This approach helps in identifying the specific toxidrome affecting the patient.

Question 17

True or False: Co-ingestions complicate the diagnosis in toxidromes.

Answer 17

True

Co-ingestions can mask symptoms or create overlapping signs.