Toxidromes

Drug ingestion both accidental and intentional accounts for a significant proportion of attendances at UK Emergency Departments and 999 calls.

In 2016 there were >2,500 registered deaths in England and Wales related to drug misuse, which had increased by nearly 60% in a decade.

So without a doubt we are all going to come across critically unwell patients with drug ingestions. But inappropriate drug use is not confined to illicit substances, with many prescription drugs being misused to ill effect and also overdosed in an attempt to end patients lives.

In this podcast we’re going to run through the assessment of patients presenting with a possible drug ingestion, cover the potential toxidromes you may encounter and talk about the management of these presentations. Specifically we take a look at serotonin syndrome, sedative toxidrome and both cholinergic and anti-cholinergic syndrome.

In next months Roadside to Resus we’ll take a look at specific medications of overdose; paracetamol, beta blockers, calcium channel blockers and the intricacies of their management along with other key parts of critical care including the management of cardiac arrest due to toxicity.

Make sure to take a look at the references and resources below.

Enjoy!

SimonRob & James

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References

EMCrit;Tox-hound idromes

RCEM 2019; Drug Misuse and the Emergency Department

RCEM; Induction book 2 Toxicology

Pharmacokinetics of N-acetylcysteine in man. Borgström L European Journal of Clinical Pharmacology. 1986

Management of the critically poisoned patient. Jennifer S Boyle. Scand J Trauma Resusc Emerg Med. 2009

Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review.Cave G. Acad Emerg Med. 2009

Lipid resuscitation for local anesthetic toxicity: is it really lifesaving? Leskiw U. Curr Opin Anaesthesiol. 2009

Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Sirianni AJ Ann Emerg Med. 2008

Toxbase

The Role of Sodium Bicarbonate in the Management of Some Toxic Ingestions. Aibek E. Mirrakhimov. Int J Nephrol. 2017

LITFL; Calcium channel blocker toxicity

VICE; Heroin Users Who’ve OD’d Talk About Being Brought Back from the Brink

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