Consider GI decon with Activated Charcoal if patient presents <2 hours after ingestion and remains cooperative
Decreases the risk of hyperthermia, rhabdo, traumatic injuries
Benzos are agents of choice especially increase seizure threshold
Repeat boluses every 5-15 minutes as needed to halt seizures and provide adequate sedation
Goal: QRS duration < 110 msec
Repeat boluses every 5-15 minutes as needed to halt seizures and provide adequate sedation
Goal: QRS duration < 110 msec
Indicated for severe agitation or delirium (esp if unresponsive to benzos)
Contraindicated in QRS>100 or Na blockade signs (R' in aVR) and in narrow angle glaucoma
Relatively contraindicated in asthma or ileus
Physostigmine - strongly consider poison control consult before giving
Crosses blood brain barrier, can be used to help make dx
Dosing: 0.5mg-1mg IV over 5min (repeat dosing up to 2mg in first hour)
Onset of action: 5-10min
If partial response, repeat x3
If 3 or more administrations are needed over a 6-hour period, start IV infusion (bolus 1-2 mg followed by 1 mg/hour)
Stop infusion every 12 hours to determine resolution of the toxidrome
Side effects: bradycardia, dysrhythmias, cholinergic excess
Always have atropine at the bedside for bradycardia or cholinergic excess</ref>
Contraindicated in TCA toxicity (associated with cardiac arrest) and in the presence of bradycardia or AV block
Crosses blood brain barrier, can be used to help make dx
Dosing: 0.5mg-1mg IV over 5min (repeat dosing up to 2mg in first hour)
Onset of action: 5-10min
If partial response, repeat x3
If 3 or more administrations are needed over a 6-hour period, start IV infusion (bolus 1-2 mg followed by 1 mg/hour)
Stop infusion every 12 hours to determine resolution of the toxidrome
Side effects: bradycardia, dysrhythmias, cholinergic excess
Always have atropine at the bedside for bradycardia or cholinergic excess</ref>
Contraindicated in TCA toxicity (associated with cardiac arrest) and in the presence of bradycardia or AV block
Sodium bicarbonate for conduction abnormalities (QRS prolongation)
2 mEq/kg bolus (typically 2-3 amps of bicarb)
Begin continuous NaCO3 infusion at 250mL/hr if bolus effective
Solution preparation = 1L D5W mixed with 3 ampules NaHCO3
2 mEq/kg bolus (typically 2-3 amps of bicarb)
Begin continuous NaCO3 infusion at 250mL/hr if bolus effective
Solution preparation = 1L D5W mixed with 3 ampules NaHCO3
Synthetic cathinone toxicity
Sympathomimetic toxicity
Monoamine oxidase inhibitor toxicity
Red, dry skin and absent bowel sounds favors anticholinergic toxicity
Marijuana toxicity
Encephalitis
Benzodiazepine toxicity
Head trauma