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Toxidromes — NREMT Cheat Sheet
Read the pattern, not the story
👤 By the CinnaEMS Content Team
🕐 Updated 2026-09-24
🏷️ Clinical Judgment
🔖 Free to read, print, and share
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Use this quick-reference guide to recognise, treat and hand over Toxidromes on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Mirrors
Anticholinergic: DRY, hot, dilated, fast, retaining Cholinergic: WET everywhere, small pupils, slow 📌 Kills By
Cholinergic → secretions → suction + ventilate Opioid → respirations → ventilate BEFORE naloxone 📌 The Split
Sympathomimetic sweats Anticholinergic does not 📚 Toxidromes — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
Recognizing a poisoning by its pattern rather than by what the patient or bystanders say was taken. Two of them are exact mirrors of one another, which is why they are examined together.
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Key points Understand these first Anticholinergic: dry, flushed, hot, dilated pupils, tachycardic, retaining urine. Cholinergic: wet everywhere, constricted pupils, bradycardic, fasciculating. Opioid: depressed respirations with pinpoint pupils — ventilate before the antidote. Sympathomimetic: agitated, dilated, tachycardic, but DIAPHORETIC — the sweat splits it from anticholinergic.
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Nursing priorities What to do, in order Cholinergic kills through secretions — airway and suction first. Opioid death is respiratory — ventilation precedes naloxone.
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Red flags — report now Escalate immediately Fasciculations with copious secretions Hot dry skin with agitation and retention
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Patient teaching What patients must know Sweat is the single finding that separates sympathomimetic from anticholinergic.
❓ Toxidromes: NREMT FAQs
What are the priority actions for Toxidromes in the field? Cholinergic kills through secretions — airway and suction first. Opioid death is respiratory — ventilation precedes naloxone.
What findings in Toxidromes change your plan or your transport decision? Fasciculations with copious secretions. Hot dry skin with agitation and retention.
What do I need to know about Toxidromes for the NREMT? Anticholinergic: dry, flushed, hot, dilated pupils, tachycardic, retaining urine. Cholinergic: wet everywhere, constricted pupils, bradycardic, fasciculating. Opioid: depressed respirations with pinpoint pupils — ventilate before the antidote. Sympathomimetic: agitated, dilated, tachycardic, but DIAPHORETIC — the sweat splits it from anticholinergic.
What should the crew communicate or document for Toxidromes? Sweat is the single finding that separates sympathomimetic from anticholinergic.
✨ Quick Tip Anticholinergic: dry, flushed, hot, dilated pupils, tachycardic, retaining urine.
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