Toxicology NOS

  • Material data safety sheet

Ddx includes:
thryoid storm
infection, meningitis,enchephalitis
metabolic derangement, hepatic encephalopathy
head trauma, CVA
CO2 narcosis
post ictal state
melignant hypertension

Smart Note:

_ suspected agent
_ suspected time of ingestion
_ suspect route of ingestion
_ pill count
_ collateral by PMD/pharmarcy/poolice to search pt’s home
_ pill identification


Toxicologic Exam:
    _ HR
     _ LOC
     _ pupils
     _ skin
     no stigmata of IVDU
     no n/v/d
     no palpable bladder suggestive urinary distention
    no neck mass/peri-thyroid neck scar

     _ pregnancy test
     _ POC glucose
     _ EKG (to eval for abnormal intervals)
     _ ingestion labs (acetominophen, ASA)
     _ BMP to eval for potential anion gap acidosis
     _ given above presentation, the following diagnostics are _ indicated: 
CK, UA to eval for rhabomyolysis
CT head to eval for intracranial process as alternative etiology’s to pt’s condition
deferred LP given afebrile, hx not c/w meningitis and suspected toxicologic etiology, and no signs of meningismus

Evaluated patient for characteristic toxidromes on exam and pt’s presentation is not consistent with the following toxidromes given the pt does NOT have the characteristic findings as detailed parenthetically below:

-anticholinergic (Tachycardic, delirium, mydriasis, axilla skin, flushed skin, dry mucus membranes, urinary retention)
-Sympathometic ( tachycardic , paranoia, mydriasis , diaphoresis ) 
-Opioid/sedation/ alcohol (bradycardic, decreased level of consciousness, miosis) 
-Cholinergic ( wet skin, increased G.I. motility (nausea, vomiting, diarrhea), miosis )
Considered administration of glucose, thiamine, naloxone, however given the hx/exam and above presentation was not consistent with Wernicke’s, hypoglycemia, nor opioid overdose, these interventions are not indicated at this time. 

Medical Clearance:

Medically cleared for psychiatric evaluation.

No acute medical emergency requiring medical intervention prior to psychiatric evaluation.

The brief medical screening evaluation (history and physical) did not reveal any clear medical conditions which are thought to be more likely as causative to the patient’s psychiatric complaints than primarily psychiatric pathology. Given the most likely etiology for the patient’s symptoms at this time would require an emergent psych evaluation and the risks of delayed psychiatric evaluation outweigh the benefit of further medical evaluation at this time, the patient is to be evaluated by psychiatry. This emergency medical screening examination does exclude all underlying medical conditions which may be contributory or exacerbating the patient’s psychiatric complaints (as this is not feasible to be done in an medical screening exam). Additionally, the patient may have additional comorbidities/medical need which will need to be addressed on an non-emergent basis.

DIAGNOSIS: psychiatric disorder NOS

COUNSELLING: Patient informed of treatment plan.

Leave a Comment