Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Poisons and Toxidromes

Poisons and Toxidromes

Pdf Summary

The presentation titled "Poisons & Toxidromes" by Dr. Edward E. Conway Jr. from Jacobi Medical Center covers various aspects of poisoning, toxic agents, and management of toxidromes. <br /><br />It begins with a mnemonic for altered mental status (A Alcohol, E Encephalitis/ Electrolytes/Endocrine, I Ingestions/Infection, etc.) to aid in differential diagnosis. Toxidromes, symptom profiles associated with specific types of toxins, are highlighted, encompassing several categories:<br /><br />1. <strong>Sympathomimetic</strong>: Drugs like cocaine and amphetamines result in hyperactivity and sympathetic stimulation.<br />2. <strong>Anticholinergic</strong>: Substances like antihistamines, tricyclic antidepressants (TCA), and atropine which can cause symptoms such as dry mouth, dilated pupils, and hallucinations.<br />3. <strong>Cholinergic</strong>: Commonly caused by organophosphates and nerve agents, leading to sludgy symptoms (Salivation, Lacrimation, Urinary retention, Defecation, GI cramps, Emesis).<br /><br />A significant section is dedicated to organophosphates, detailing their mechanism of action and treatment. They inhibit acetylcholinesterase, causing a cholinergic crisis and are treated with atropine and pralidoxime (2-PAM).<br /><br />Several drug classes with potential for overdose and toxicity are reviewed:<br /><br />- <strong>Opiates</strong>: Including morphine, fentanyl, heroin, and methadone.<br />- <strong>Sedatives/Hypnotics</strong>: Such as benzodiazepines and ethanol.<br />- <strong>Serotonin Syndrome</strong>: Caused by MAOIs, SSRIs, meperidine, and dextromethorphan.<br />- <strong>Hallucinogens</strong>: Including LSD, PCP, and MDMA.<br />- <strong>Neuroleptics</strong>: Drugs like chlorpromazine and haloperidol.<br /><br />Key points include the importance of initiating resuscitation (A, B, C, D, E approach) without knowing the exact intoxicant, recognizing that toxidromes may overlap, and understanding that infants and children respond differently to medications compared to adults.<br /><br />Lastly, it emphasizes the need for clinicians to comprehend these toxidromes and be prepared with immediate interventions. Normal head CT scans are mentioned, possibly implying the use of imaging in diagnostic processes for altered mental status.

Keywords

Poisons

Toxidromes

Dr. Edward E. Conway Jr.

Jacobi Medical Center

Sympathomimetic

Anticholinergic

Cholinergic

Organophosphates

Serotonin Syndrome

Resuscitation

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