I brought the DantasticTox guys back to discuss how toxidrome really present, you know in real life.
If you missed their first EMCrit episode, go listen:
and then check out the Dantastic Tox Podcast
Altered, but will give you 3 seconds of attention
Big, non-reactive pupils (constrictors knocked out); Pupils may not even be enormous until you stimulate and then they get wide
Dry-everywhere. Put a gloved hand in the axilla if you are brave like Howard
Voice–Worst cottonmouth ever
Picking behaviors (this is the big one) – they will be plucking at EVERYTHING. Taking off gown.
Stimulus evoked tachycardia
Bowel Sounds-screw bowel sounds, because DEMONS
Like Spongebob when you squeeze-water comes from everywhere
“SLUDGE”: Salivation, Lacrimation, Urination, Defecation, GI cramping, Emesis + “Killer B’s”: Bronchorrhea, Bradycardia, Bronchospasm
Pooping on themselves
So remember cardiogenic shock with crying and diarrhea and pinpoint pupils.
Mydriasis, but briskly reactive (i.e. they will constrict when you shine light)
Psychomotor agitation, Paranoia, Psychotic, but they will respond to questions (but you won't like the answers)
Blunts fatigue, pain response, and exhaustion
Sedative/ETOH Withdrawal can only really be differentiated by history
bradypnea first then look at the pupils
Benzo plus is where the problem comes
Now on to the Podcast…
- EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - April 4, 2020
- EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer - March 31, 2020
- EMCrit Wee – Stop Kneejerk Intubation with the EMCrit Crew - March 30, 2020