Common toxidromes, overdose presentations, and antidotes for prehospital and emergency department poisoning cases.
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- What is the antidote for opioid overdose?
- Naloxone (Narcan)
- What classic triad of signs suggests opioid overdose?
- Pinpoint pupils (miosis), respiratory depression, and decreased level of consciousness
- What routes can an EMT-B give naloxone?
- Intranasal, intramuscular, or intravenous
- What is the antidote for benzodiazepine overdose?
- Flumazenil
- Why is flumazenil rarely used in an undifferentiated overdose?
- It can precipitate seizures, especially with co-ingestion or chronic benzodiazepine use
- What toxidrome features dry skin, dilated pupils, a flushed face, and confusion?
- Anticholinergic toxidrome
- The mnemonic 'red as a beet, dry as a bone, blind as a bat, mad as a hatter' describes which toxidrome?
- Anticholinergic toxidrome
- What toxidrome features excess salivation, lacrimation, urination, and defecation (SLUDGE)?
- Cholinergic toxidrome, seen in organophosphate poisoning
- What is the antidote for organophosphate (cholinergic) poisoning?
- Atropine
- How does atropine work in organophosphate poisoning?
- It blocks muscarinic acetylcholine receptors, drying up secretions
- What toxidrome features agitation, tachycardia, hypertension, dilated pupils, and sweating?
- Sympathomimetic toxidrome, as with cocaine or methamphetamine
- How do sympathomimetic and anticholinergic toxidromes differ on skin exam?
- Sympathomimetic causes sweaty skin; anticholinergic causes dry skin
- What toxidrome features slurred speech, ataxia, and CNS/respiratory depression?
- Sedative-hypnotic toxidrome, as with benzodiazepines, barbiturates, or alcohol
- What is the typical first-line prehospital treatment for a recent toxic ingestion, if protocol allows?
- Activated charcoal
- What is a key contraindication for giving activated charcoal?
- Decreased level of consciousness or inability to protect the airway