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