Hi everyone, its Jessica, and welcome to CritIC: the tox series!
Toxidromes are a collection of symptoms frequently seen in poisoned patients.
Recognize the toxidrome, and youll have a better understanding of what the patient
has taken, how to treat it and to anticipate for problems to come.
This video covers the sedative-hypnotic toxidrome.
Lets get started.
The sedative-hypnotic toxidrome, or short: the sedative toxidrome, is easy to remember.
It resembles the opioid toxidrome a lot, and it is kind of like the inverse of the sympathomimetic
toxidrome.
Therefore, please watch the videos on the sympathomimetic toxidrome and the opioid toxidrome
first.
There is great overlap, but Ill focus mostly on the differences.
When assessing the patient with the sedative toxidrome, this is what youll typically see.
In A, if your patient has a reduced level of consciousness, then the airway is threatened.
Apply the triple airway maneuver.
If your patient breathes insufficiently, start bagging.
In B, severe bradypnea.
If severe enough, oxygen saturation will start to fall.
Watch out for aspiration and monitor respiration closely.
Start bagging if needed.
In C, bradycardia and hypotension, but they rarely cause complications on its own.
Beware of co-ingested medication that could cause cardiac arrhythmias.
In D, pupil size is normal.
They have a depressed mental status and could therefore lose their respiratory drive, so monitor B.
In E, bowel sounds are reduced but they dont have ileus.
Body temperature is normal, but beware of hypothermia and rhabdomyolysis if patients
have been lying on the floor for an unknown period of time.
Their skin feels normal to cold.
Through our ABCDE assessment, weve figured out that this is a sedative toxidrome:
all vitals are downregulated and the patient has normal pupils.
We can thus anticipate for possible complications, like respiratory depression.
We should therefore get the appropriate blood work: an arterial blood gas, liver and renal
panel with electrolytes, CK, etc.
Dont forget the tox screen.
Weve also provided respiratory support.
Move on to risk assessment: can the patient tell you what he took, when, etc?
Common sedatives are alcohol and benzodiazepines.
Note that in sedative overdose there is frequently a co-ingestion with other meds like paracetamol,
antipsychotics or antidepressants.
Next, go through the general steps of treatment, as discussed in the introductory video.
Note the contra-indications for decontamination if the patient is comatose.
Theres an antidote for benzodiazepines called flumazenil,
but as of late, were extremely reserved in its usage.
This is for two reasons.
1. These patients are usually chronic users and could go into withdrawal
2. If its a suicide attempt, they usually co-ingested other medication.
And since these are usually psychiatric patients, chances are the co-ingested medication are
antipsychotics or tricyclic antidepressants which could cause seizures and cardiac arrhythmias.
The sedative intoxication should therefore be regarded as their protection for more severe complications.
So the most important treatment is supportive and respiratory care with close cardiac monitoring.
Thats all on the sedative toxidrome.
Let me know what you think in the comments below!
Thanks!
