1. Toxidromes Brad Peckler MD Lincoln Hospital Center Bronx, New York

2. Diagnostic Odors Cyanide Isopropanol Placidyl Hemlock Hydrogen sulfide Camphor Phosgene Naphthalene Op’s/ Arsenic Hydrocarbons Methylsalicylate Chloral hydrate Zinc phosphate Paradichlorobenzene

3. But as the world is harmoniously confused: Where order in variety we see, And where, though all things differ, all agree. Alexander Pope

4. 69 y/o male with chronic low back pain presents with change in mental status.

5. 28 y/o woman found in bathroom found unconscious with a syringe on the floor.

6. Narcotics Hypoventilation Pinpoint pupils Somnolence ~Hypotension

7. Narcotics MeperidineVagolytic Serotonin syndrome Noromeperidine PropoxypheneProlonged QT Mixed agonist/antagonist Synthetic opiates Drug combinations

8. 18 y/o male brought in by NYPD because he’s acting crazy and violent. HR 144 BP 180/90 RR 22 Diaphoretic, 8mm pupils

9. Sympathomimetics HTN Tachycardia Mydriasis Diaphoresis CNS excitement

10. Sympathomimetics Drugs of abuse Adrenergic agonists Amphetamines Cocaine PCP TCA Early MAOI Sedative/hypnotic withdrawal

11. 70 y/o female used a flea bomb in her house and forgot to open the windows before entering the house C/o eye tearing, SOB, vomiting

12. Cholinergic crisis Organophosphates Organophosphothionates Carbamates Insecticides Nerve agents 2-PAM

13. Organophosphates Acetylcholinesterase AcetylcholineNo hydrolysis Nervous tissue and RBC Concentrated in CNS Parasympathetic nerve endings Sympathetic nerve endings Somatic nerves Autonomic ganglia Pseudocholinesterase Liver and serum

14. Muscarinic Diarrhea Urination Meiosis Bronchospasm/secreti ons Emesis Lacrimination Salvation/sweating SLUDGE + Bradycardia Nicotinic CNS NMJ Adrenal Ganglia Sweating +Tachycardia +Hypertension

15. 18 y/o male BIBPD c/o hallucinations and “cotton mouth” OE: temp 102, distended abdomen

16. Visual Hallucinations Anticholinergics Sympathomimetics LSD PCP GHB Psilocybin Pentamidine Nutmeg/Mace Functional Organic Migraines Encephalitis Rabies Digoxin/Methanol Alcohol intoxication Alcohol withdrawal

17. Hallucinations Olfactory Migrane, Pre-seizure, Acidosis, FB Frontal lobe tumor Sensory DT’s, Cocaine, Menapause, HCG, Liver dz Auditory Functional, ASA, CN VIII

18. 25 y/o female took some pills Comatose, dry mucous membrane, tachycardic, had a seizure at home.

19. Anticholinergics TCA Scopolamine/polo Neuroleptics Parkinson meds Benzotropine/trihexphendyl Jimson weed AntihistaminesMethylqualone PiperdonesGyromitra

20. TCA Anticholinesterase inhibitor Alpha blocker Sodium channel blocker (1A) Amine uptake inhibitor GABA inhibitor

21. Anticholinergic vs Sympathomimetc Dry Wet Absent bowel soundsNL bowel sounds PsychosisAgitatedMydriasisHyperthermia RedFlushed Tachy/BP ?Tachy/HTN

22. 60 y/o prisoner with AMS and a suicide note. Had a seizure en route to hospital and has continued to seize for 45 minutes After ABC’s FS 402 7.22/22/360

23. Status Epilepticus INH Theophylline Hypoglycemia

24. Seizure Hyperglycemia Metabolic Acidosis INH ASA DKA Theophylline CO/CN Anticholinergic Phenytoin