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/