Toxic agents and abnormal vital signs


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


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)

References and Links

  • Erickson TB et al. The Approach to the Patient with an Unknown Overdose. EMCNA. 2007, 25: 249-81.

References and Links

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of, the RAGE podcast, the Resuscitology course, and the SMACC conference.

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

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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