Opioids → naloxone, titrated to breathing; ventilate with a bag-mask first.
Before you read
Test yourself first: 1 question
Question 1 of 1
A patient who drank from an unlabeled container in a garage has blurred vision, deep rapid breathing and appears intoxicated without the smell of alcohol. Consider:
Answer: A. Methanol and ethylene glycol are metabolized into acids, so the patient looks drunk while a severe metabolic acidosis develops underneath, with visual disturbance pointing at methanol in particular. The absence of an alcohol smell with deep rapid breathing is the clue that this is not ordinary intoxication, and these poisonings have specific antidotes that only work early.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- Opioids → naloxone, titrated to breathing; ventilate with a bag-mask first.
- Organophosphates and nerve agents → atropine for secretions, plus pralidoxime.
- Cyanide → hydroxocobalamin; carbon monoxide → high-concentration oxygen.
- Tricyclic overdose with a wide QRS → sodium bicarbonate.
- Beta-blocker overdose → glucagon; calcium channel blocker overdose → calcium.
Field priorities
- Scene safety and decontamination before patient contact.
- Support airway, breathing and circulation — the antidote is second.
- Bring containers and contact poison control.
Coaching the patient
- Pulse oximetry reads carboxyhemoglobin as normal — a normal SpO2 does not rule out CO.
- Atropine end point in organophosphate poisoning is drying of the secretions, not the pupils.
Red flags: act now
- Wide QRS or seizures after an ingestion
- Excessive secretions with pinpoint pupils
- Normal SpO2 in a smoke-exposed patient who looks sick
Toxicology & Antidotes: FAQs
What are the priority actions for Toxicology & Antidotes in the field?
Scene safety and decontamination before patient contact. Support airway, breathing and circulation — the antidote is second. Bring containers and contact poison control.
What findings in Toxicology & Antidotes change your plan or your transport decision?
Wide QRS or seizures after an ingestion. Excessive secretions with pinpoint pupils. Normal SpO2 in a smoke-exposed patient who looks sick.
What do I need to know about Toxicology & Antidotes for the NREMT?
Opioids → naloxone, titrated to breathing; ventilate with a bag-mask first. Organophosphates and nerve agents → atropine for secretions, plus pralidoxime. Cyanide → hydroxocobalamin; carbon monoxide → high-concentration oxygen. Tricyclic overdose with a wide QRS → sodium bicarbonate.
What should the crew communicate or document for Toxicology & Antidotes?
Pulse oximetry reads carboxyhemoglobin as normal — a normal SpO2 does not rule out CO. Atropine end point in organophosphate poisoning is drying of the secretions, not the pupils.
