Expansion
Anticholinergic, cholinergic, sympathomimetic, opioid and sedative patterns
Expansion
| Toxidrome | Pupils | Skin | Other |
|---|---|---|---|
| Anticholinergic | Dilated | Dry, flushed | Hot, delirium, retention, tachycardia. Dry as a bone, red as a beet, blind as a bat, mad as a hatter, hot as a hare |
| Cholinergic | Pinpoint | Sweaty | DUMBBELLS: diarrhoea, urination, miosis, bronchospasm, bradycardia, emesis, lacrimation, salivation |
| Sympathomimetic | Dilated | Sweaty | Hypertension, tachycardia, agitation, hyperthermia (cocaine, amfetamines) |
| Opioid | Pinpoint | Normal | Respiratory depression, reduced consciousness, hypotension |
| Sedative | Normal or small | Normal | Reduced consciousness with preserved respiration until deep |
| Serotonergic | Dilated | Sweaty | Clonus, hyperreflexia, agitation, hyperthermia |
The single most useful pair of observations is pupils plus sweating. Anticholinergic and sympathomimetic both dilate the pupils, but the anticholinergic patient is dry and the sympathomimetic soaked. Cholinergic and opioid both constrict, but the cholinergic patient is wet and bronchorrhoeic.
General management applies throughout: airway, breathing and circulation first, consider activated charcoal within an hour for most ingestions, correct glucose and temperature, and contact a poisons service. Gastric lavage and forced emesis are obsolete.