CCS Drug Toxicity: Antidepressant

depressed elderly pt in coma, respi dep.. widened qrs on ekg..tca overdose.

ensure ABC

1. Order: ordered oxygen, iv access and gave triple combo (thiamine, dextrose 50% and naloxone-all are iv bolus) (Don't go first for physical exam in this case. Unconsciousness/unstable pt warrants urgent treatment) 2. Do brief physical of 3min

3. start her on normal saline, 4. Labs: cbcd, SMA12 ekg 12 lead, cxr portable, pulseox, ekg monitoring, ua, urine drug scrren, blood alcohol, blood aspirin and bl acetaminophen level,

5. Rx:

Gastric lavage. (which revealed pills fragments) Activated charcoal with intermittent gastric suctioning Induce alkalinisation with NaHCo3 to maintain pH of 7.45 to7.55 If he is intubated hyperventilate to a PCo2 not< 25mmHg If ECG normal and patient is asymptomatic, observe for 6 hrs in ER otherwise admit into icu After Admission ECG should be normal for 24hrs to discharge for psychiatric disposition

counsel to stop alcohol.