What do you do when a drug affects almost every receptor you can remember? Sodium channel blockade, alpha blockade, anticholinergic effects, and antihistamines. Like many scenarios in toxicology, one of the most important things you can do is avoid acidaemia. This and excellent supportive care are the things most likely to save a patient's life.
1) Give activated charcoal
2) Avoid apnoea due to seizures or muscle paralysis (e.g. when intubating)
3) Use bicarbonate/hyperventilation to increase pH
4) Give vasopressors
5) Anticipate deterioration and intubate early if appropriate
If you enjoyed the video, please like and subscribe as it helps the KZfaq algorithm tell me what worked well and I like the feedback.
Leave suggestions for video ideas in the comments!
Please note, this video is not medical advice
References:
Bailey B, Buckley NA, Amre DK. A meta-analysis of prognostic indicators to predict seizures, arrhythmias or death after tricyclic antidepressant overdose. J Toxicol Clin Toxicol 2004;42(6):877-88.
Bateman DN. Tricyclic antidepressant poisoning: central nervous system effects and management. Toxicol Rev 2005;24(3):181-6.
Bradberry SM, Thanacoody HK, Watt BE, Thomas SH, Vale JA. Management of the cardiovascular complications of tricyclic antidepressant poisoning: role of sodium bicarbonate. Toxicol Rev 2005;24(3):195-204.
Caravati EM. The electrocardiogram as a diagnostic discriminator for acute tricyclic antidepressant poisoning. J Toxicol Clin Toxicol 1999;37(1):113-5.
Dargan PI, Colbridge MG, Jones AL. The management of tricyclic antidepressant poisoning : the role of gut decontamination, extracorporeal procedures and fab antibody fragments. Toxicol Rev 2005;24(3):187-94.
Dassanayake TL, Jones AL, Michie PT, Carter GL, McElduff P, Stokes BJ, et al. Risk of road traffic accidents in patients discharged following treatment for psychotropic drug overdose: a self-controlled case series study in Australia. CNS Drugs 2012;26(3):269-76.
Dassanayake TL, Michie PT, Jones AL, Mallard T, Whyte IM, Carter GL. Cognitive skills underlying driving in patients discharged following self-poisoning with central nervous system depressant drugs. Traffic Inj Prev 2012;13(5):450-7.
Liebelt EL, Francis PD, Woolf AD. ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Ann Emerg Med 1995;26(2):195-201.
Thanacoody HK, Thomas SH. Tricyclic antidepressant poisoning: cardiovascular toxicity. Toxicol Rev 2005;24(3):205-14.
Woolf AD, Erdman AR, Nelson LS, Caravati EM, Cobaugh DJ, Booze LL, et al. Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 2007;45(3):203-33.