Intoxications with sedatives, antidepressants, narcotics and opiates

1. Big picture

This topic is an emergency toxicology pattern-recognition topic. The examiner wants you to recognize three dangerous clinical patterns quickly:

Group	Main immediate danger	Classic clue
Sedatives/hypnotics	coma, airway loss, respiratory depression, aspiration	sleepy, ataxic, slurred speech, usually normal pupils
Opiates/opioids/narcotics	respiratory arrest	coma + miosis + bradypnea
Antidepressants, especially tricyclic antidepressants	seizures, shock, malignant arrhythmias	anticholinergic signs + wide QRS

Core emergency rule:

Poisoned unconscious patient
↓
Airway + breathing + circulation
↓
Glucose + ECG + temperature
↓
Recognize toxidrome
↓
Give antidote only when indicated
↓
Monitor for recurrence/delayed toxicity

Supportive care saves most patients. Antidotes are important, but never before Airway, Breathing, Circulation.

1. Big picture

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