![]() ![]() Pre-intubation and on arrival it is vital to get an ECG looking for signs of toxicity (widening of the QRS, large terminal R wave in aVR increased R/S ratio (>0.7) in aVR and QT prolongation).The mainstay of treatment for severe toxicity involves aggressive supportive care including the use of sodium bicarbonate for dysrhythmias and widening of the QRS alongside hyperventilation to maintain a pH >7.5-7.55.QRS widens due to fast sodium channel blockade, >100ms is predictive of seizures and >160ms is predictive of ventricular tachycardia.Severe toxicity usually manifests within 2 hours but any overdose requires close cardiac monitoring for 6 hours post ingestion.>30mg/kg = severe toxicity with pH-dependent cardiotoxicity and coma expected to last >24 hours.Anticholinergic affects are often masked by the coma 10mg/kg = Potential for coma, hypotension, seizures, cardiac dysrhythmias.>10mg/kg is potentially life threatening. ![]()
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