Toxicology

EM@3AM: Overdose

A 38-year-old male presents from triage in a hospital wheelchair with his head slumped to one side. You immediately move him into bed and assess his ABCs. He wakes briefly, but he seems to be hallucinating. Vital signs: BP 154/110, HR 110, T 102.1, RR 20, SpO2 100% on room air. Physical exam reveals mydriasis and diaphoresis. He has track marks on his arms and you find packets of what appears to be mixed prescription drugs, heroin, and methamphetamine in his pocket. What’s this presentation most consistent with? What’s your next step in evaluation and treatment?

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A Medical Toxicologist’s Approach to the Overdosed Patient

“As a medical toxicologist, I have a different take on the world of overdoses. Paracelsus has said ‘All things are poisons, for there is nothing without poisonous qualities. It is only the dose which makes a thing poison.’ Paracelsus’ adage is something that all medical toxicologists live by; however, we understand there is much more depth to the art of toxicology than the dose makes the poison.”

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