TOX TABLES
Antidepressant - Tricyclic
IMPORTANT SHIT
>5mg/kg = toxic
>10 = Major (Potentially fatal in kids)
>30 = comatose
Sodium blockade on ECG - Wide QRS, Terminal R aVR
QRS >120 = Going to seize
QRS >160 = Malignant rhythm
Clear if asymptomatic at 6h + QRS and obs OK
Propranolol = treat like TCA
>10 = Major (Potentially fatal in kids)
>30 = comatose
Sodium blockade on ECG - Wide QRS, Terminal R aVR
QRS >120 = Going to seize
QRS >160 = Malignant rhythm
Clear if asymptomatic at 6h + QRS and obs OK
Propranolol = treat like TCA
SPECIFIC ANTIDOTE
Sodium bicarbonate >> alkalosis >> decreased toxicity, Sodium load helps reverse Na blockade - 100 mmol repeat q5 min to 300.
Intubate + hyperventilate (Even during the quickest of intubations you will cause a state of acidosis which will exacerbate sodium channel toxicity.)
MDAC if >10 mg/kg
Heroics - MgSO4 + Lignocaine for VT/TdP, Charcoal haemoperfusion, intralipid, VA ECMO
Endpoints:
pH 7.5-7.55, Na 150-155, QRS <120 (?<100), SBP >100
Intubate + hyperventilate (Even during the quickest of intubations you will cause a state of acidosis which will exacerbate sodium channel toxicity.)
MDAC if >10 mg/kg
Heroics - MgSO4 + Lignocaine for VT/TdP, Charcoal haemoperfusion, intralipid, VA ECMO
Endpoints:
pH 7.5-7.55, Na 150-155, QRS <120 (?<100), SBP >100