CARDIOTOXIC OVERDOSESFive Toxic Tips and Traps

A Talk by Chris Nickson

No $

Gunja N, Graudins A. Emergency Medicine Australasia (2011) 23, 16–22

BE AN EC-TOXO-G

EXPERT! 1Photo by Lifeinthefastlane.com

Holstege CP, Eldridge DL, Rowden AK. ECG manifestations: the poisoned patient. Emerg Med Clin North Am. 2006 Feb;24(1):159-77

QRS>100ms

R’ > 3 mm

R’/S > 0.7

Holstege CP, Eldridge DL, Rowden AK. ECG manifestations: the poisoned patient. Emerg Med Clin North Am. 2006 Feb;24(1):159-77

QT>450ms

Chan A, Isbister GK, Kirkpatrick CM, Dufful SB. Drug-induced QT prolongation and torsades de pointes: evaluation of a QT nomogram. QJM. 2007 Oct;100(10):609-15. Epub 2007 Sep 19.

GIVE INSULIN EARLY & HIGH

DOSE!

2Photo by Michael Tapp

Insulin 1 unit/kg bolusand

50% glucose 50mL

Yes…1 unit/kg

Then infusions of

Insulin 0.5 unit/kg/hand

50% glucose 50mL/h

Give it Early

DON’T CRASH,OPEN THE BICARB!

3

NaHCO3 1-2 mmol/kg

thenHyperventilate to

pH 7.5-7.55

It’sMagic!

Before

After

… TO THE RESCUE !? 4

20% Intralipid1.5 mL/kg bolus

= 100 mL

+/- repeat q5min x2

20% Intralipid0.5 mL/kg/min

infusion= 400 mL/ 20 min

+/- then 400mL/ 10 min

NEVER SURRENDER!

5Photo by Zugaldia

Gunja N, Graudins A. Emergency Medicine Australasia (2011) 23, 16–22

THE END

Photo by Incurable_hippie

http://lifeinthefastlane.com/education/toxicology/