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ENVIRONMENTAL EMERGENCIES

SYMPTOMS/EXAM

■ Anticholinergic toxidrome

■ Hallucinations

■ Hyperthermia

■ Flushed skin, dry skin, and mucous membranes

■ Mydriasis

■ Tachycardia

■ Urinary retention

TREATMENT

■ Supportive (intravenous fluids, external cooling)

■ Gastric decontamination (charcoal or whole bowel irrigation)

■ Sedation with benzodiazepines

■ Physostigimine

■ Cholinesterase inhibitor

■ Use in severe cases (failure of benzodiazepines).

■ Complications include AV block, asystole.

DEADLYNIGHTSHADE(ATROPA BELLADONNA)

Deadly nightshade is a black-cherry-like fruit that contains an atropine-like

substance. Its Latin name means “pretty woman.”

MECHANISM OFTOXICITY

Ingestion→inhibition of cholinergic receptors.

Presentation and treatment are similar to jimsonweed.

Hallucinogenic Plants

MARIJUANA: HEMPPLANT(CANNABISSATIVA)

The active ingredient of marijuana is Δ-9-tetrahydrocannabinol. It can be

either smoked or eaten.

SYMPTOMS/EXAM

■ Low level exposure

■ Somnolence, euphoria, heightened sensory awareness, feeling of well-

being, alteration of time perception, and paranoia

■ High level exposure

■ Lethargy, decreased coordination, and ataxia

■ Abstinence syndrome

■ Agitation, apprehension, and insomnia

DIAGNOSIS

■ May be detected on urine toxicology screen

TREATMENT

■ GI decontamination, if large ingestion

■ Supportive care

■ Benzodiazepines for agitation