π§ͺ Toxicological emergencies are life-threatening situations caused by poisons, overdoses, or environmental exposures. Recognition of patterns + rapid supportive and antidote therapy saves lives π.
β‘ Common Toxicological Emergencies (Quick Reference)
- π Paracetamol (Acetaminophen) β RUQ pain, βLFTs, coagulopathy β‘οΈ Antidote: N-acetylcysteine (NAC).
- π Tricyclic Antidepressants (TCA) β Anticholinergic toxidrome, arrhythmias, seizures β‘οΈ Antidote: IV sodium bicarbonate.
- β οΈ Paraquat β Vomiting, pulmonary fibrosis, multi-organ failure β‘οΈ Supportive only, activated charcoal early, ICU care.
- πΎ Organophosphates β SLUDGE (salivation, lacrimation, urination, diarrhea, GI upset, emesis), bradycardia, fasciculations β‘οΈ Atropine + Pralidoxime.
- π Opioids β Coma, pinpoint pupils, respiratory depression β‘οΈ Naloxone (IV/IM/IN) + airway support.
- π₯ Carbon Monoxide β Headache, confusion, cherry-red skin, hypoxia β‘οΈ 100% Oβ, consider Hyperbaric Oβ.
- πΊ Alcohol Poisoning β CNS depression, hypoglycaemia, hypothermia β‘οΈ IV fluids, glucose, thiamine, supportive care.
- π§² Iron Overdose β GI upset, shock, liver failure β‘οΈ Deferoxamine chelation, fluids, correct acidosis.
- π Snake Bite β Swelling, bleeding, coagulopathy, shock β‘οΈ Antivenom + fluids, wound care, tetanus prophylaxis.
- π Beta-Blockers β Bradycardia, hypotension, hypoglycaemia β‘οΈ Glucagon, atropine, pacing if needed.
- π Calcium Channel Blockers β Bradycardia, hypotension, hyperglycaemia β‘οΈ IV calcium, vasopressors, high-dose insulin therapy.
- π Digoxin Toxicity β Nausea, confusion, visual halos, arrhythmias β‘οΈ Digoxin-Fab antibodies, atropine, pacing.
π©Ί Core Principles in Management
- π ABCs first: Airway, Breathing, Circulation β always stabilise before specific therapy.
- π§΄ Decontamination: Activated charcoal if within 1β2 hours (selected poisons only).
- π Antidotes: Use where available β time critical.
- π Supportive care: Fluids, Oβ, seizure control, correction of electrolytes.
- π Poison Centre: Always involve early for specialist guidance.
π§ͺ Toxidrome Map β Clinical patterns of poisoning to rapidly identify likely agents and guide antidote use π.
π΄ SedativeβHypnotic Toxidrome
- π§ CNS depression β drowsy, ataxic, coma
- π¨ Respiratory depression
- β€οΈ Bradycardia, hypotension
- π Normal pupils
- β οΈ Causes: Benzodiazepines, Barbiturates, Alcohol
- π Antidote: Flumazenil (benzos), supportive care
β‘ Sympathomimetic Toxidrome
- π§ Agitation, seizures, paranoia
- π Mydriasis (dilated pupils)
- β€οΈ Tachycardia, hypertension, arrhythmias
- π‘οΈ Hyperthermia, sweating
- β οΈ Causes: Cocaine, Amphetamines, MDMA
- π Antidote: Benzodiazepines, cooling, supportive
πΏ Cholinergic Toxidrome (SLUDGE)
- π¦ Salivation, Lacrimation, Urination, Diarrhoea
- π€’ GI cramps, Emesis
- π Miosis (pinpoint pupils)
- π¨ Bronchospasm, bronchorrhoea β respiratory failure
- β οΈ Causes: Organophosphates, Carbamates
- π Antidote: Atropine + Pralidoxime
π¬ Anticholinergic Toxidrome
- π§ Agitation, hallucinations, delirium
- π Mydriasis (dilated pupils)
- π‘οΈ Hyperthermia, flushed skin, dry mouth
- π§ Urinary retention, β bowel sounds
- β οΈ Causes: Antihistamines, TCAs, Atropine, Antipsychotics
- π Antidote: Physostigmine (with caution), supportive
π Opioid Toxidrome
- π§ CNS depression, coma
- π¨ Respiratory depression β apnoea
- π Miosis (pinpoint pupils)
- β€οΈ Bradycardia, hypotension
- β οΈ Causes: Morphine, Heroin, Methadone, Fentanyl
- π Antidote: Naloxone