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Hot as a hare, mad as a hatter: Cracking the toxidrome code

Before you grab the naloxone or reach for the benzos, hit play on this toxidrome masterclass

In this episode of the Inside EMS podcast, hosts Chris Cebollero and Kelly Grayson dig deep into one of EMS’s most overlooked (and often forgotten) topics — toxidromes. You might remember the word from paramedic class, but today’s street calls demand more than a vague memory. With patients taking everything from grandma’s Ativan to street-made speed, understanding toxidromes is crucial for making quick, accurate clinical calls.

The crew breaks down the five major toxidromes every medic should know: anticholinergic, cholinergic, opioid, sympathomimetic and sedative-hypnotic. From classic mnemonics like “mad as a hatter” to real-life stories of fire ant poisonings, this episode serves up practical knowledge with EMS-grade humor.

Chris and Kelly cover telltale signs (sweaty vs. dry skin, pinpoint vs. dilated pupils), treatment pearls of wisdom (easy on that naloxone, folks), and the real-world complications of polypharmacy. Plus, they touch on lesser-known players like serotonin syndrome and hallucinogens.

This one’s a refresher you didn’t know you needed — but you’ll be grateful when you respond to your next overdose call.

Memorable quotes

  • “Antidotes are overrated. Supportive care will take care of most of the toxidromes out there.” — Kelly Grayson
  • “If they’re pleasantly stuporous but breathing effectively, it’s not an overdose. It’s just a dose.” — Kelly Grayson
  • “Narcan is not a punishment, it’s a treatment. You don’t slam it, you bump it just a little bit, just enough to get them breathing again.” — Kelly Grayson

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The Inside EMS podcast is a regular expert discussion of hot topics, clinical issues, operational and leadership lessons for EMTs, paramedics and chiefs