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Opioids (Opioid Toxidrome)

Concise toxidrome definition: Opioid agonism leading to pinpoint pupils (miosis) and CNS and respiratory depression.

Rationale or reasoning for toxidrome decisions: The name was chosen based upon clinical relevance and accuracy as well as ease of recall. Examples of names initially considered included: Opioids, Sedative, Solvent, and changed mental status unresponsive with or without seizures.

Issues or concerns about this toxidrome:  Recognition of airway compromise may be paramount; the applicability of naloxone.

Opioid examples of industrial chemicals and potential chemical warfare/terrorism agents: Carfentanil and other fentanyl derivatives, and other opioids (e.g., diacetylmorphine).

The clinically relevant routes of exposure and types of sources: Inhalation and ingestion.

The organ systems generally affected: Central nervous system (CNS), including central apnea), ocular (miosis), gastrointestinal (GI), and respiratory (secondary effects).

The initial signs and symptoms: Decreased mentation, decreased pupil size (miosis) [most opioids], decreased respirations, decreased pulse, decreased blood pressure, decreased temperature, and decreased GI motility.

A progression of signs and symptoms includes: Drowsiness with eventual pinpoint pupils and progressing to loss of consciousness, airway compromise, and respiratory arrest; rapidly fatal after loss of airway and respirations if untreated.

The underlying pathology, biological processes, or modes of action include: Opioid-receptor agonism.

Common treatment protocol, specific antidotes and key supportive measures: Naloxone, and airway and breathing support.

Report to the Toxic Chemical Syndrome Definitions and Nomenclature Workshop (PDF - 2.01 MB) (DHS, NLM, May, 2012)

Information from Other Resources

Resource Comparison Table of Resource Comparison
Information from CDC, WISER, and CAMEO
Emergency Response Safety and Health Database (CDC/NIOSH) click here to open link
  • ERSH-DB is a occupational safety and health database developed by NIOSH for the emergency response community.
  • Contains high-priority agents in terrorist events
  • Information includes:
    • Agent characteristics
    • Personal protective equipment
    • Emergency response
    • Signs/symptoms
    • Decontamination
    • First aid
    • Long-term implications
    • On-site fatalities
    • Occupational exposure limits
    • Acute expousre guidelines
    • Decontamination (environmental and equipment)
    • Agent properties
    • Hazardous materials warning labels/placards
    • Trade names and other synonyms
    • Who to contact in an emergency
    • Important notice
  • None
WISER (NIH/NLM) click here to open link
  • WISER is a system designed to assist first responders in HAZMAT incidents.
  • Data derived from HSDB and DOT Emergency Response Guidebook
  • Information includes:
    • Substance identification
    • Protective equipment/clothing
    • Protective distance
    • Fire fighting procedures
    • Reactivities/incompatibilities
    • Treatment overview
    • and many more...
  • None
CAMEO (EPA, NOAA) click here to open link
  • CAMEO is a database of response information for thousands of hazardous materials
  • MyChemicals: build a customized list of chemicals
  • Predicts reactivity of 2 chemicals
  • Information includes:
    • Chemical identifiers
    • Hazards
    • Response recommendations
    • Physical properties
    • Regulatory information
    • Alternate chemical names
  • None
Medical Management Guidelines for Acute Chemical Exposures (CDC/ATSDR) click here to open link
  • MMGs for Acute Chemical Exposures were developed by ATSDR to aid emergency department physicians and other emergency healthcare professionals.
  • Guidelines for managing acute exposures resulting from chemical incidents
  • Information includes:
    • Basic chemical and exposure information
    • Summary of potential health effects
    • Prehospital management information
    • Emergency department management information
    • Information for the patient
  • None
Chemical Emergencies (CDC) click here to open link
  • A collection of CDC resources for professionals, including:
    • Case definition
    • Toxic syndrome description
    • Toxicology profiles
    • Training
    • First responders
    • Medical management
    • Emergency response cards
    • Lab info
    • Surveillance
    • Preparation & planning

Additional Resources:

ChemIDplus - Chemical dictionary, structures, and links to many Internet resources (NIH/NLM)
Carfentanil and other Fentanyl derivatives, and other opioids (e.g., Diacetylmorphine).

Hazardous Substances Data Bank - Comprehensive, peer-reviewed toxicology data (NIH/NLM)
Fentanyl derivatives, and other opioids (e.g., Diacetylmorphine).

Report on Toxic Chemical Syndromes: Definitions and Nomenclature (PDF - 2.01 MB)

An Interagency Agreement between the Department of Homeland Security (DHS) Office of Health Affairs (OHA) and the National Library of Medicine led to a workshop to discuss and develop a consistent lexicon to describe toxic chemical syndromes, or toxidromes. This workshop included practitioners and experts in emergency response, emergency medicine, and medical toxicology developed names and definitions for twelve unique toxidromes that describe and differentiate the clinical signs and symptoms from exposures to chemicals. These toxidromes focus on acute signs and symptoms caused by inhalation and dermal exposures, and each toxidrome is characterized by exposure routes and sources, organs/systems affected, initial signs and symptoms, underlying mode of action, and treatment/antidotes. The toxidrome names and definitions are designed to be readily understood and remembered by users since communication in a crisis requires accurate and succinct terms that can quickly convey the health conditions of patients. These toxidromes lay the foundation for a consistent lexicon for use in CHEMM and for other uses that, if adopted widely, will improve response to chemical mass exposure incidents.

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