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Toxic agents and abnormal vital signs

Overview

Abnormal vital signs in patient’s following toxic exposures can suggest underlying toxidromes.

Causes

12
Bradycardia (PACED)
  • Propranolol/ beta-blockers, poppies (opiates), propoxyphene, physostigmine
  • Anticholinesterases, antiarrhythmics
  • Clonidine, calcium channel blockers
  • Ethanol or other alcohols
  • Digoxin, digitalis
Tachycardia (FAST)
  • Free base or other cocaine forms, Freon
  • Anticholinergics, antihistamine, antipsychotic, amphetamines, alcohol withdrawal
  • Sympathomimentics, solvent use, strychnine
  • Theophylline, TCAs, thyroid hormones
 
Hypothermia (COOLS)
  • C arbon monoxide
  • O pioids
  • O ral hypoglycemics and insulin
  • L iquor (alcohol)
  • S edative-hypnotics
Hyperthermia (NASA)
  • N euroleptic malignant syndrome, nicotine
  • A ntihistamine, alcohol withdrawal
  • S alicylates, sympathomimetics, serotonin syndrome
  • A nticholinergics, antidepressants, antipsychotics
Hypotension (CRASH)
  • C lonidine, calcium channel blockers
  • R odenticides (has arsenic, cyanide)
  • A ntidepressants, aminophylline, antihypertensives
  • S edative-hypnotics
  • H eroin or other opiate
Hypertension (CT SCAN)
  • C ocaine
  • T hyroid supplements
  • S ympathomimetics
  • C affeine
  • A nticholinergics, amphetamines
  • N icotine
Tachypnea (PANT)
  • P CP, paraquat, pneumonitis (chemical), phosgene
  • A SA and other salicylates
  • N oncardiogenic pulmonary edema, nerve agents
  • T oxin-mediated metabolic acidosis
Bradypnea (SLOW)
  • S edative-hypnotics
  • L iquor (alcohols)
  • O pioids
  • W eed (marijuana)
  • Erickson TB et al. The Approach to the Patient with an Unknown Overdose. EMCNA. 2007, 25: 249-81.

References and Links

CCC Differential Diagnosis Series

NEURO

Anosmia, Ataxia, Blepharospasm, Bulbar and Pseudobulbar palsy, Central Pontine Myelinosis, Cerebellar Disease, Chorea, Cranial nerve lesions, Dementia, Dystonia, Exophthalmos, Eye trauma, Facial twitches, Fixed dilated pupil, Horner syndrome, Loss of vision, Meningism, Movement disorders, Optic disc abnormality, Parkinsonism, Peripheral neuropathy, Radiculopathy, Red eye, Retinal Haemorrhage, Seizures, Sudden severe headache, Tremor, Tunnel vision

RESP

Bronchial breath sounds, Bronchiectasis, High airway pressures, Massive haemoptysis, Sore throat, Tracheal displacement

CVS

Atrial Fibrillation, Bradycardia, Cardiac Failure, Chest Pain, Murmurs, Post-resuscitation syndrome, Pulseless Electrical Activity (PEA), Pulsus Paradoxus, Shock, Supraventricular tachycardia (SVT), Tachycardia, VT and VF, SVC Obstruction

GIT

Abdominal distension, Abdominal mass, Abdominal pain, Asterixis, Dysphagia, Hepatomegaly, Hepatosplenomegaly, Large bowel obstruction, Liver palpation abnormalities, Lower GI haemorrhage, Malabsorption, Medical causes of abdominal pain, Rectal mass, Small bowel obstruction, Upper GI Haemorrhage

GUT

Genital ulcers, Groin lump, Scrotal mass, Urine colour, Urine Odour, Urine transparency, 

MSK

Arthritis, Shoulder pain, Wasting of the small muscles of the hand

DERM

Palmar erythema, Serious skin signs in sick patients, Thickened Tethered Skin, Leg ulcers, Skin Tumour, Acanthosis Nigricans

ENDO

Diabetes Insipidus, Diffuse Goitre, Gynaecomastia, Hirsutism, Hypoglycaemia, SIADH, Weight Loss

HAEM

Splenomegaly

PAEDS

Floppy infant 

MISC

Anaphylaxis, Autoimmune associated diseases, Clubbing, Parotid Swelling, Splinter haemorrhages, Toxic agents and abnormal vitals, Toxicological causes of cardiac arrest

IMAGING

CHEST: Atelectasis, Hilar adenopathy, Hilar enlargement on CXR, Honeycomb lung, Increased interstitial markings, Mediastinal widening on mobile CXR, Pulmonary fibrosis, Pseudoinfiltrates on CXR, Pulmonary opacities on CXR,
ABDO: Gas on abdominal X-ray, Kidney mass,
BRAIN: Intracranial calcification, Intracranial structures with contrast, Ventriculomegaly,
OTHER: Pseudofracture on X-Ray, 

LABS

LOW: Anaemia, Hypocalcaemia, hypochloraemia, Hypomagnesaemia, 

HIGH: Bilirubin and Jaundice, Hyperammonaemia, Hypercalcaemia, Hyperchloraemia, Hyperkalaemia, Hypermagnesaemia, 

ACID BASE: Acid base disorders, Resp. acidosis, Resp. alkalosis,

Creatinine, CRP, Dipstick Urinalysis, Laboratory Urinalysis, Liver function tests (LFTs), Pleural fluid analysis, Urea, Urea Creatinine Ratio, Uric acid, Urinalysis, Urine Electrolytes

[cite]

CCC 700 6

Critical Care

Compendium

…more CCC

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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