• In the setting of Hs and Ts refer to medications, illicit drugs, or various chemicals ​
• Lead to cardiac arrest typically when consumed in OVERDOSE quantities ​
  • This may be intentional or unintentional ​
• The effects on the body that lead to cardiac arrest depend on the type of toxin that was consumed​
• Some examples:​
  • Digoxin - Lethal dysrhythmias ​
  • Benzodiazepines - Respiratory depression/apnea​
  • Cocaine - Lethal dysrhythmias, or MI, or excited delirium  (HyperK, metabolic acidosis) 

Why Leave Early?

In short, antidotes!​
​
The hospital may have antidotes available for the specific toxin that was consumed. Recognizing the toxin and potential for overdose is key for considering early transport. If you do not have a clear story, consider remaining and treating per the standard Medical Cardiac Arrest medical directive.

What about Opioids?

While technically falling into the definition of "toxin", overdose consumption of opioids alone does not qualify a person for early transport under the ALS PCS.​​

Why?​

• You have the tools best suited to treat the patient​
• Priority management of ABCs and if time and resources permit, you can consider naloxone. ​

However, if the person has very clearly consumed an opioid AND another type of toxin, then consider early transport (for the underlying other toxin). 

In Summary

• Toxins in the setting of Hs and Ts refer to medications, illicit drugs, or chemicals​
• consumption in (typically) overdose amounts can affect body systems in various ways (drug dependent) and be lethal​
• Hospitals may have an antidote to the toxin. Therefore, non-opioid drug toxicity as the suspected cause of arrest is a reason for very early transport​
• Opioids (in isolation, not a mixed overdsoe) do not fall under a consideration for very early transport since their toxicity can be managed by paramedics 

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