Chapter 9: EMERGENCY MEDICINE & TOXICOLOGY

NOTE: Taking the MOC? Know this section cold!

MENTAL STATUS CHANGES

If the child is mobile, mental status changes may indicate medication or toxic ingestion.

PEARL: Did the question mention a FAMILY MEMBER’S medical history? Ingestions are often NOT obser­ved and may be related to a family member’s disease (e.g., hypoglycemia from a diabetic medication, or hypotension from antihypertensive medications).

PUPILS

Normal pupil size is 3 mm.

PEARL: If any other pupil size is mentioned, it is probably a hint.

MIOSIS

Miosis means small pupils (technically, 2 mm or less). This can be caused by clonidine, cholinergics, opioids, organophosphates, phenothiazine, pilocarpine, and sedatives/barbiturates.

MNEMONICS: CoPS know to look for small pupils. o o

• C – Clonidine and CHOLinergics
• o– Opioids and ORGANo Perhaps the “ORGAN” in ORGANophosphates could remind you of a COLON and the COLON-ergic side effects of ORGANophosphates!
• P – Phenothiazine, pilocarpine (Know this cholinergic!), phencyclidine
• S – Sedatives and barbiturates

MYDRIASIS

Mydriasis means large pupils (technically, 5mm or more) and can be caused by antihistamines, anti­depressants, anticholinergics, and sympathomimetics.

MNEMONIC: Think of how BIG your eyes got the first time you realized the benefit of ‘AAA Savings”!!! If you have an AAA® card, you can save on cars, hotels, and more!

• A – ANTIhistamine
• A – ANTIdepressants
• A – ANTIcholinergics (Atropine)
• S – Sympathomimetics (amphetamines, cocaine, phencyclidine)

PEARL: Phencyclidine can cause either miosis or mydriasis!

NYSTAGMUS

Nystagmus can be caused by alcohol, lithium, anticonvulsants, and PCP. PCP can cause vertical OR horizontal nystagmus.

DIAPHORESIS

Diaphoresis (AKA sweating or perspiration) can be caused by sympathomimetics, organophosphates, aspirin, and phencyclidine.

MNEMONIC: Sweaty/diaphoretic skin needs SOAP!

• Sympathomimetics
• Organophosphates (and CHOLINERGICS in general)
• Aspirin
• Phencyclidine (PCP)