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NEUROTOXICOLOGY CASES    KEVIN OCONNELL MD
“Jesus”    35y/o male brought in by police, destroyed    apartment, yelling that he was Jesus, agitated    requiring mult...
“Jesus”    Tox neg, ETOH neg, ASA and APAP neg    EKG: sinus tach, nl intervals    Eval by mental health    Transfer t...
Signout    “Walking Rounds”    “I saw that guy a few days ago and he was    normal”    Given Hycodan for cough/bronchit...
Hycodan    Hydrocodone and homatropine cough syrup    Anticholinergic med
ANTICHOLINERGIC TOXICITY    Inhibition of muscarinic cholinergic    neurotransmission    “red as a beet, dry as a bone, ...
Treatment    Benzodiazepines    Supportive care    Physostigmine
Case #2 “Agitated”    37 y/o female presents agitated, confused.    Family denies any med or drug use. Sick for    few da...
“Agitated”    Pupils 6-7 mm bilat    Skin dry, flushed    Delirium    Icteric sclera
“Agitated”    EKG: sinus tach, nl intervals    Tox: neg    CBC nl, chem nl, creat=2.0    T Bili=5.6    AST=1450    A...
Treatment    IV fluids, Ativan    IV NAC    VIT K (INR=2.3)    Physostigmine for delirium/agitation    ICU (Transfer ...
Other Anticholinergics    Military agents/Terrorist agents    “Incapacitants”    BZ – (3 Quinuclidinyl Benzilate)    A...
Jimson Weed    Anticholinergic    Used by kids    hallucinations    agitation
Mushrooms    Muscaria
Case #3 “Too much body fluids”    45 y/o male drank bottle of insecticide as    overdose attempt    Vomiting, sweaty, in...
Organophosphates Overdose    SLUDGE: salivation, lacrimation, urination,    defecation, GI distress, emesis    Dont forg...
Mad as a Hatter    Where is this from    Also found in Minamata Bay
Mercury Poisoning    Central and peripheral symptoms    Organic/elemental/ organic mercury    Infants and children have...
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EMS Neurotoxicology Cases

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EMS Neurotoxicology Cases

  1. 1. NEUROTOXICOLOGY CASES KEVIN OCONNELL MD
  2. 2. “Jesus” 35y/o male brought in by police, destroyed apartment, yelling that he was Jesus, agitated requiring multiple officers to bring him to ER in handcuffs P=110, Temp=100F BP190/85 RR=20 No previous psych hx Ativan and Haldol for sedation
  3. 3. “Jesus” Tox neg, ETOH neg, ASA and APAP neg EKG: sinus tach, nl intervals Eval by mental health Transfer to psych facility
  4. 4. Signout “Walking Rounds” “I saw that guy a few days ago and he was normal” Given Hycodan for cough/bronchitis Cancel psych transfer – admit ICU
  5. 5. Hycodan Hydrocodone and homatropine cough syrup Anticholinergic med
  6. 6. ANTICHOLINERGIC TOXICITY Inhibition of muscarinic cholinergic neurotransmission “red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare” Tachycardia, hallucinations, delerium
  7. 7. Treatment Benzodiazepines Supportive care Physostigmine
  8. 8. Case #2 “Agitated” 37 y/o female presents agitated, confused. Family denies any med or drug use. Sick for few days, decrease po intake, nausea. Patient unable to answer any questions, trying to get off stretcher. Fluctuating level of consciousness, confused. P=130s BP= 140/80 RR=24 T=37c
  9. 9. “Agitated” Pupils 6-7 mm bilat Skin dry, flushed Delirium Icteric sclera
  10. 10. “Agitated” EKG: sinus tach, nl intervals Tox: neg CBC nl, chem nl, creat=2.0 T Bili=5.6 AST=1450 ALT= 5000 APAP=108
  11. 11. Treatment IV fluids, Ativan IV NAC VIT K (INR=2.3) Physostigmine for delirium/agitation ICU (Transfer to Boston)
  12. 12. Other Anticholinergics Military agents/Terrorist agents “Incapacitants” BZ – (3 Quinuclidinyl Benzilate) Agent 15
  13. 13. Jimson Weed Anticholinergic Used by kids hallucinations agitation
  14. 14. Mushrooms Muscaria
  15. 15. Case #3 “Too much body fluids” 45 y/o male drank bottle of insecticide as overdose attempt Vomiting, sweaty, incontinent of urine and feces SOB Restless, anxious, tremulous BP=170/80 P=120 RR=28 T=37 Hazmat suits for decon
  16. 16. Organophosphates Overdose SLUDGE: salivation, lacrimation, urination, defecation, GI distress, emesis Dont forget bronchorrhea DUMBELS: diarrhea, urination, miosis, bronchorrhea, emesis, lacrimation, salivation Inhibits AchE Carbamates, V and G nerve gases similar
  17. 17. Mad as a Hatter Where is this from Also found in Minamata Bay
  18. 18. Mercury Poisoning Central and peripheral symptoms Organic/elemental/ organic mercury Infants and children have worse effects Accumulation in fish

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