Toxicology is it’s own speciality, and we rely on the help of poison control centres and toxicologists to manage more complex intoxications. In the ER we need a method to quickly consider whether or not someone’s presentation may be a toxicological problem, and there are a couple of approaches

After you run through ABCDEFGH, consider “I” for Intoxication, and whether the patient’s presentation may be related to broad sources of INTOX:


  • alcohols: ethanol, methanol, ethylene glycol, isopropyl alcohol
  • cocaine
  • mairjuana
  • ecstasy
  • GHB


  • hepatic toxicity: mushrooms
  • anti-cholinergic: jimson weed, belladonna
  • ephedrine: Ma Huang

Treatments, by system

  • B: theophylline, INH
  • C: anti-hypertensive, ACE inhibitor, Beta blocker, CCB, Dig
  • D: sedative, anti-depressant, anti-psychotic, anti-convulsant, lithiumopioid
  • E: insulin, sulfonylurea, synthroid, steroid/withdrawal
  • F
  • G
  • H: anti-coagulant, anti-platelet


  • tylenol
  • aspirin

X poison

  • hydrocarbon
  • caustic
  • heavy metas
  • organophosphate
  • carbon monoxide
  • cyanide


Another approach to the undifferentiated toxicology emergencies is to consider what body systems are affected:


-hypersalivation, emesis: cholinergic

-caustic ingestions


-tachypnea: think PANT: Pneumo (cocaine barotrauma)/Paraquat, ASA, Non-cardiogenic pulmonary edema, Toxin metabolic acidosis

-bradypnea: think SLOW: Sedative, Liquor, Opioid, Weed


-bradycardia: think PACED: Pesticide, Anti-arrhythmic, CCB/Clonidine, Etoh, Digoxin

-tachycardic: think FAST: Freon, Anticholinergic/Alcohol withdrawal, Sympathetic (caffeine, cocaine), TCA/thyroid/theophylline

-hypotensive: think CRASH: CCB/Clonidine, Rodendricide, Antidepressant, Sedative, Heroin/Hemorrhage (GI bleed from ASA/NSAID/alcohol)

-hypertensive: think STIMulate: Sympath Thyroid Inhale cocaine Mad as hatter (anticholinergic)



-lethargic: Lead/lithium Etoh/ethylene glycol TCA Heroin/hypoglycemic/heavy metal Arsenic/antipsyc Rohypnol GHB INH/insulin Clonidine/cyanide/CO

-seizure: Sympath/salicylate Etoh withdrawal/ethylene glycol INH/insulin benZo withdrawal Elevated lithium/lead

-miosis: if the cops pull you over to shin a light in your eyes, think COPS: Cholinergic/Clonidine, Opiate/organophosphate, Pilocarpine Sedative

-mydriasis: SAW: Sympath, Antichol, Withdrawal


-hypothermia: think COOLS: Carbon monoxide, Opioid, Oral hypoglycaemic, Liquor, Sedative

-hyperthermia: hot as the sun in space, think NASA: NMS, Alcohol withdrawal, Salicylate/serotonin/sympath, Antichol/antipsyc

-diaphoresis, so sweaty you need SOAP: Sympath, Organophosphate, Aspirin, Phencyclidine



-tablets visible on KUB are like COINS: Chloral hydrate/cocaine/Calcium, Opium packet, Iron/heavy metal, Neuloptic, Sustained release




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