Are there other people involved?Does the patient have a significant past medicalhistory?Is the patient’s condition improving/deteriorating?The presence of a toxic syndrome or toxidrome canhelp establish that a poison has been involved bysuggesting the class of poison(s) to which the patient mayhave been exposed. Table 5-1 provides a list of commonlyencountered toxidromes, their sources and symptoms.The “non-syndrome syndrome” is of specialimportance. The only method to recognize the potentialfor a delayed onset poisoning to occur is to suspect thepossibility from the history or presentation of a person.In some cases, the individual’s affect or behavior mayprovide a clue. In other cases, the examiner must rely onclinical experience or even a hunch.GENERAL TREATMENTOnce poisoning has been established, the generalrule is to quickly remove as much of the toxicsubstance from the victim as possible. The method ofremoval of the poison varies depending upon how thepoison was introduced:Ingested poisons: There is a choice betweenemetics and gastric lavage, followed byadsorbents and cathartics.Inhaled poisons: Oxygen ventilation is themethod of choice.Absorbed poisons: Removal of the poison isprimarily attained by cleansing the skin.Injected poisons: Antidotal medications arerecommended.INGESTED POISONSIngested poisons are those poisons which havebeen consumed, whether accidentally or intentionally,by the victim. Ingestion is the most common route ofexposure to toxic materials in the home.The local actions of an ingested poison can haveirritant, acidic (corrosive), or basic (caustic) effects atthe site of contact.5-3Syndrome Sources Signs & Symptomsnarcotic opiates, benzodiazepines, barbituratesAbeady eyes,@ sunglasses, decreased blood pressure,CNS and respiratory depressionwithdrawalalcohol, barbiturates, benzodiazepines,narcotics, sedative-hypnoticsdiarrhea, dilated pupils, goose bumps, increased heartrate, tearing, yawning, stomach cramps, hallucinationssympathomimetictheophylline, caffeine, LSD, PCP,amphetamine, cocaine, decongestantsCNS excitation (confusion, incoordination, agitation,hallucination, delirium, seizures), increased bloodpressure and heart rateanticholinergicantihistamines, atropine, scopolamine,antidepressants, anti-Parkinson L ,antipsychotics, antispasmodics, mush-rooms, hallucinogens, antidepressantsdry skin, increased heart rate, dilated pupils, fever,urinary retention, decreased bowel sounds, CNSexcitationcholinergic organophosphates, carbamates, physostig-mine, neostigmine, endrophoniumASLUDGE@: increased salivation, lacrimation,urination, defecation, GI cramping, emesis; CNS(headache, restless, anxiety, confusion, coma,seizures); muscle weakness and fasciculationsn o n - s y n d r o m esyndromevarious chemicals with delayed onset due tobiotransformation, depletion of naturaldetoxifying agent, accumulation of dose oreffectfrom Anothing@ to minor complaints that initially appearto be trivialTable 5-1.—Commonly Encountered Toxidromes
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