As winter and holidays approaches, so does all the blues that comes with it.
You are working a shift and your PCT hands you an ekg:
UH OH! Where is this patient? Now what? What is it? Whatever it is, it doesn’t look good. You go check on the patient and found her to be altered, minimally responsive. Off to resus she goes. Family member has a picture of what she might have taken. Call Poison. 212-POISONS (212-764-7667).
TCA is rapidly absorbed and has a first pass metabolism.
Effects of TCA:
Treatment:
-If patient is not able to protect airway, then consider having a definitive airway
-If <1hr, lavage or place OG and give charcoal
-Sodium bibarb! Have a lot of amps ready, give until QRS <100. Initial dose of 1-2meq/kg given as rapid IVP. Repeat every 3-5 minutes. Have continuous EKG running. Once QRS narrow, place on drip. If you run out there are studies that support hypertonic saline.
-Fluid bolus for hypotension. Levophed if refractory
-Benzo, benzo, benzo, and then more benzo for seizures
-Lidocaine for arrhythmia
-Magnesium with Torsades
-Correct electrolytes: hypokalemia/hypocalcemia
-Intralipid if peri-code as TCA is lipophilic
-If all else fails. ECMO
For more info:
https://litfl.com/tricyclic-overdose-sodium-channel-blocker-toxicity/
https://emj.bmj.com/content/18/4/236
https://emcrit.org/emcrit/tricyclic-antidepressant-overdose/