cardiotoxic overdoses - 5 toxic tips and traps
DESCRIPTION
A talk on cardiotoxic overdoses by Chris Nickson. It was given at the Bedside Critical Care conference in the Whitsunday Islands.TRANSCRIPT
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CARDIOTOXIC OVERDOSESFive Toxic Tips and Traps
A Talk by Chris Nickson
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No $
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Gunja N, Graudins A. Emergency Medicine Australasia (2011) 23, 16–22
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BE AN EC-TOXO-G
EXPERT! 1Photo by Lifeinthefastlane.com
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Holstege CP, Eldridge DL, Rowden AK. ECG manifestations: the poisoned patient. Emerg Med Clin North Am. 2006 Feb;24(1):159-77
QRS>100ms
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R’ > 3 mm
R’/S > 0.7
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Holstege CP, Eldridge DL, Rowden AK. ECG manifestations: the poisoned patient. Emerg Med Clin North Am. 2006 Feb;24(1):159-77
QT>450ms
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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.
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GIVE INSULIN EARLY & HIGH
DOSE!
2Photo by Michael Tapp
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Insulin 1 unit/kg bolusand
50% glucose 50mL
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Yes…1 unit/kg
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Then infusions of
Insulin 0.5 unit/kg/hand
50% glucose 50mL/h
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Give it Early
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DON’T CRASH,OPEN THE BICARB!
3
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NaHCO3 1-2 mmol/kg
thenHyperventilate to
pH 7.5-7.55
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It’sMagic!
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Before
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After
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… TO THE RESCUE !? 4
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20% Intralipid1.5 mL/kg bolus
= 100 mL
+/- repeat q5min x2
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20% Intralipid0.5 mL/kg/min
infusion= 400 mL/ 20 min
+/- then 400mL/ 10 min
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NEVER SURRENDER!
5Photo by Zugaldia
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Gunja N, Graudins A. Emergency Medicine Australasia (2011) 23, 16–22
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THE END
Photo by Incurable_hippie
http://lifeinthefastlane.com/education/toxicology/