Ingestion of toxic substances: The Daily PANCE Blueprint
Which of the following is indicated if a patient overdoses on a tricyclic antidepressant and the EKG demonstrates a widening of the QRS complex (>100 msec)?
A. Sodium bicarbonate
B. Diazepam
C. Cyproheptadine
D. Benadryl
E. Dantrolene
Answer and topic summary
The answer is A. Sodium bicarbonate
Tricyclic antidepressant (TCA) overdose is serious and can be life-threatening. Clinical features include AMS, seizures, and EKG changes. Serial EKG monitoring is important in TCA overdose patient given they are at risk for going into ventricular tachycardia or ventricular fibrillation. It’s recommended to initiate sodium bicarbonate therapy with QRS >100msec or if the patient goes into a ventricular arrhythmia. Further management includes supportive care (secure airway, breathing, circulation), GI decontamination (with activated charcoal if they present within 2 hours of ingestion), and benzodiazepines for seizures.
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