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

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

Enjoying the show? Email the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.