14d • Paramedic Talk
Let's talk about Toxidromes
Here's some common toxidromes seen on your exams!
NREMT Mini Lecture: Overdoses & Toxidromes
Opioid Overdose
Mechanism
- CNS and respiratory depression
Key Findings
- Respiratory depression (MOST important)
- Miosis (pinpoint pupils)
- Decreased LOC
EMS Treatment
- Airway + ventilations FIRST
- Naloxone (Narcan)
- Oxygen
NREMT Pearl
Ventilate before Narcan — hypoxia kills first.
Organophosphate / Cholinergic Overdose
Mechanism
- Inhibits acetylcholinesterase → excess acetylcholine
Key Findings (DUMBELS)
- Diarrhea
- Urination
- Miosis
- Bronchospasm / Bradycardia
- Emesis
- Lacrimation
- Salivation
EMS Treatment
- Atropine
- Pralidoxime (2-PAM)
- Decontamination (PPE!)
NREMT Pearl
Wet patient = cholinergic toxicity
Anticholinergic Overdose
Mechanism
- Blocks acetylcholine
Key Findings
- Hot, dry skin
- Dilated pupils (mydriasis)
- Tachycardia
- Altered mental status
Classic Phrase
“Hot as a hare, dry as a bone, blind as a bat, mad as a hatter”
EMS Treatment
- Supportive care
- Benzos for agitation
- Cooling if needed
Sympathomimetic Overdose
Causes
- Cocaine, amphetamines
Key Findings
- Tachycardia
- Hypertension
- Diaphoresis
- Dilated pupils
- Agitation
Key Difference from Anticholinergic
- Sympathomimetic = sweating
- Anticholinergic = dry
EMS Treatment
- Benzodiazepines
- Cooling
- Cardiac monitoring
Beta Blocker Overdose
Mechanism
- Blocks beta receptors → ↓ HR and ↓ contractility
Key Findings
- Bradycardia
- Hypotension
- Possible hypoglycemia
EMS Treatment
- Glucagon (KEY DRUG)
- Fluids
- Atropine (may be ineffective)
NREMT Pearl
Beta blocker OD → Glucagon
Calcium Channel Blocker (CCB) Overdose
Mechanism
- Blocks calcium → ↓ contractility + vasodilation
Key Findings
- Bradycardia
- Hypotension
- Weak pulses
EMS Treatment
- Calcium (calcium chloride or gluconate)
- Fluids
- Consider pacing
NREMT Pearl
CCB overdose = give calcium
Potassium Channel Blocker Overdose
Mechanism
- Prolongs repolarization
Key Findings
- Prolonged QT interval
- Risk of torsades de pointes
EMS Treatment
- Magnesium sulfate
NREMT Pearl
Long QT → think magnesium
Tricyclic Antidepressant (TCA) Overdose
Mechanism
- Sodium channel blockade
Key Findings
- Wide QRS
- Tachycardia
- Altered mental status
- Seizures
EMS Treatment
- Sodium bicarbonate (KEY)
- Benzodiazepines for seizures
NREMT Pearl
Wide QRS + overdose → give sodium bicarb
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Let's talk about Toxidromes
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