toxidrome
patient presents with:
-normal temperature
-increased HR
-HTN
-increased respiratory rate
-dilated pupils
-diaphoresis
-has goose flesh on exam
bonus: what is the treatment
Opioid withdraw toxidrome/intoxication
bonus: supportive care (possible methadone or suboxone)
learning point:
gooseflesh is unique to this toxidrome
name the two ways you can test for drugs
bonus: which is the best/why
blood or urine
bonus: urine, because drugs can be bound to proteins in the blood causing false results and also in the urine you can detect drugs that were used more remotely in the past.
patient presents with:
-fever
-tachycardia
-HTN
-initially normal respiratory rate but becomes tachypneic
-dilated pupils
-diaphoresis
bonus: what is the treatment
stimulant toxidrome
Bonus: benzos and possible antipsychotic (haldol)
what are the two major benefits of a urine drug screen
1.) can confirm admitted substance use
2.) can see if there were any other ingestions
patient presents with:
-fever
-tachycardia
-HTN
-normal respiratory rate
-dilated pupils
-NO diaphoresis
-also is experiencing hallucinations and you bladder scan them and they feel like they need to pee but can't
bonus: what is the treatment
Anticholinergic toxidrome
Bonus: benzodiazepine
learning point:
biggest difference between anticholinergic toxidrome and stimulant toxidrome is the lack of diaphoresis with anticholinergic toxicity
What is the specific compound that a drug screen tests for to detect cannabinoids?
bonus: what can it not detect because of this
Delta THC 9
Bonus: cannot detect altered forms such as spice or K2
patient presents with:
-normal temperature
-initially normal BP that starts to drop
-HR that is initially normal but starts to become bradycardic
-CONSTRICTED pupils
-no diaphoresis
bonus: what is the treatment
acute opioid intoxication toxidrome
Bonus:
Rx - naloxone (narcan)
what things are not typically detected by a drug screen?
metals
lithium
theophylline
ethylene glycol (evaporates too quickly)
ANTIDIABETIC DRUGS
BACLOFEN
also a simple urine drug screen will generally not pick up synthetic drugs like K2, spice, or fentanyl
patient presents with:
-normal temperature
-normal heart rate
-normal blood pressure
-respiratory rate that is normal but then starts becoming bradypneic
-pupils appear normal
-altered mental status
-you administer treatment and they start seizing
bonus: what is the treatment
sedative hypnotic (specifically benzodiazepine) overdose/toxidrome
Bonus: flumazenil
learning point:
if you give flumazenil to a benzodiazepine naive patient you can cause them to seize and it will be refractory to seizure meds as the treatment for seizures is benzodiazepines
what are the general classifications of substances a basic urine drug screen is able to test for?
A- amphetamines
B- benzodiazepines/barbiturates
C- cannabadiols
O- opiates
P- PCP
T- TCA