Cardiovascular Toxidromes Managment

Question 1

Challenges of Cardio Toxidromes
(5)

Answer 1

• pt may become toxic without overdose
• pt may be agitated and non-compliant due to toxicity
• complex, compound and/or bizarre dysrrhythmias
• high chance of refractory presentations
• electrolytic and/or metabolic disturbances

Question 2

Cardio Toxidrome Management
Bradycardia
(4)

Answer 2

• atropine
• adrenaline
• transcutaneous pacing
• CPR if unconscious & <40BPM or PEA

Question 3

Cardio Toxidrome Management
Hypotension
(4)

Answer 3

• IV fluids, reassess every 250-500mLs (10 mL/kg paeds)
• end point adequate GCS or MAP 90mmHg
• adrenaline
• if metabolic then correct hypoglycaemia or hypothermia

Question 4

Cardio Toxidrome Management
Sodium Channel Blockers

Answer 4

• prone to seizures
• QRS > 0.14 ms + terminal R wave in aVR the sodium bicarbonate 8.4% to be given
• prone to refractory VT/VF to amiodarone

Question 5

Cardio Toxidrome Management
Beta Blocker Toxicity

Answer 5

• propranolol, QRS ? 0.14ms + terminal R wave then sodium bicarbonate 8.4% to be given
• solatol K+ blockade prolongs QT, if TdP give magnesium sulphate
• correct any hypoglycaemia presentations

Question 6

Cardio Toxidrome Management
Beta Blocker Toxicity

Answer 6

• propranolol, QRS ? 0.14ms + terminal R wave then sodium bicarbonate 8.4% to be given
• solatol K+ blockade prolongs QT, if TdP give magnesium sulphate
• correct any hypoglycaemia presentations

Question 7

ECG Findings (3)

Answer 7

• prolonged PR interval
• wide QRS
• terminal R wave

Question 8

Calcium Channel Blocker Toxicity
Treatment

Answer 8

• consider safety and QPS back up
• pt sedation
• ALL vitals, including 12-Lead for baseline
• consider oxygen and IV access
• if bradycardic or hypotensive then treat with IV fluid, atropine, adrenaline and subcut pacing

Question 9

Calcium Channel Blocker Toxicity
verapamil and/or diltiazem
Treatment Plan

Answer 9

same as normal treatment but can consider calcium gluconate

Question 10

Digoxin Toxicity
Treatment Plan

Answer 10

• consider safety and QPS back up
• pt sedation
• ALL vitals, including 12-Lead for baseline
• rapid transportation for in-hospital antidote
• consider oxygen and IV access
• if bradycardic or hypotensive then treat with IV fluid, atropine, adrenaline and subcut pacing
• expect high level blocks and refractory VT/VF

Question 11

Why do we use Atropine for bradycardia?

Answer 11

• anticholinergic inhibits vagus innervation of the heart
• loss of parasympathetic tone raises heart rate/contractility
• reduces airway secretions
• mydriasis (pupil dilation)

Question 12

Cardiovascular Toxidromes Management
Salt Infusions
Sodium Bicarbonate
Effect

Answer 12

• provides extracellular sodium to overcome block
• reverses metabolic acidosis by reacting to H+ ions

Question 13

Cardiovascular Toxidromes Management
Salt Infusions
Calcium Gluconate
Effect

Answer 13

• improves contractility
• myocardial protection in hyperkalaemia
• provides extracellular calcium to overcome block

Question 14

Cardiovascular Toxidromes Management
Salt Infusions
Magnesium Sulphate
Effect

Answer 14

• stabilises membranes in TdP by reducing calcium influx to cell

Question 15

Cardiovascular Toxidrome Treatment Plan
Oral Anticoagulant

Answer 15

• supportive treatment
• may have blood in airway, suction with care
• IV for fluid resus
• keep pt warm to avoid coagulopathy
• transfer to high level care for antidotes
• hospital may use TXA