1) Agents Affecting Pupil Size
i) Miosis (COPS)
(a) Cholinergic, clonidine, carbamates
(b) Opioids, organophosphates
(c) Phenothiazines (antipsychotics), pilocarpine, pontine haemorrhage
(d) Sedative – hypnotics
ii) Mydriasis (SAW)
(a) Sympathomimetics
(b) Anticholinergics
(c) Withdrawal syndromes
2) Agents Causing Coma or Seizures
i) Coma (LETHARGIC)
(a) Lead, lithium
(b) Ethanol, ethylene glycol, ethchlorvyol
(c) Tricyclic antidepressants, thallium, toluene
(d) Heroin, hemlock, hepatic encephalopathy, heavy metals, hydrogen sulphide, hypoglycaemics
(e) Arsenic, antidepressants, anticonvulsants, antipsychotics, antihistamines
(f) Rohypnol (sedative hypnotics), risperidone
(g) Gamma-hydroxybutyrate (GHB)
(h) Isoniazid, insulin
(i) Carbon monoxide, cyanide, clonidine
ii) Seizures (OTIS CAMPBELL)
(a) Organophosphates, oral hypoglycaemics
(b) Tricyclic antidepressants
(c) Isoniazid, insulin
(d) Sympathomimetics, strychnine, salicylates
(e) Camphor, cocaine, carbon monoxide, cyanide, chlorinated hydrocarbons
(f) Amphetamines, anticholinergics
(g) Methylxanthines (theophylline, caffeine), methanol
(h) Phencyclidine (PCP), propranolol
(i) Benzodiazepine withdrawal, botanicals (water hemlock, nicotine), bupropion, GHB
(j) Ethanol withdrawal, ethylene glycol
(k) Lithium, lidocaine
(l) Lead, lindane
3) Cholinergic Toxidrome
i) Muscarinic (DUMBELLS)
(a) Diarrhoea, diaphoresis
(b) Urination
(c) Miosis
(d) Bradycardia
(e) Emesis
(f) Lacrimation
(g) Lethargic
(h) Salivation
ii) Nicotinic: Days of the Week
(a) Mydriasis
(b) Tachycardia
(c) Weakness
(d) Tremors
(e) Fasiculations
(f) Seizures
(g) Somnolent
iii) Anticholinergic Reveal Mnemonics
(a) Blind as a bat;
(b) Mad as a hatter;
(c) Red as a beet;
(d) Hot as Hades/Hell/Desert;
(e) Dry as a bone;
(f) The bowel and bladder lose their tone, and the heart runs alone.
Or…
a) Can’t See (blurred vision);
b) Can’t pee (urinary retention);
c) Can’t spit (dry mouth);
d) Can’t Shit (constipated)
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