Adult TCA OD

Question 1

Adult TCA OD - Initial actions?

Answer 1

IV/IO
Fluid bolus up to 40 ml/kg, goal MAP 65
ECG

Question 2

Adult TCA OD - Signs of cardiotoxicity?

Answer 2

Refractory hypotension
QRS > 0.10
Ventricular dysrhythmia

Question 3

Adult TCA OD - Cardiotoxicity treatment?

Answer 3

Sodium Bicarbonate 1 mEq/kg q 5 until resolution of symptoms

Question 4

Adult TCA OD - Pt seizing?

Answer 4

Treat with concurrently with seizure protocol

Question 5

Adult TCA OD - Ventricular dysrhythmia unresponsive to sodium bicarbonate?

Answer 5

Magnesium Sulfate 2 g in 50 ml over 5 min

Question 6

Adult TCA OD - Which neurotransmitters are effected by TCAs?

Answer 6

Norepinephrine and serotonin

Question 7

Adult TCA OD - Unstable VT treatment in TCA OD treatment?

Answer 7

Synchronized cardioversion

Question 8

Adult TCA OD - Unstable polymorphic VT in TCA OD treatment?

Answer 8

Defibrillation

Question 9

Adult TCA OD - Sodium Bicarbonate dose?

Answer 9

1 mEq/kg SIVP/IO

q 5 min prn until cardiotoxicity resolved

Question 10

Adult TCA OD - Sodium Bicarbonate indication?

Answer 10

TCA OD with cardiotoxicity:
refractory hypotension
QRS > 0.10
ventricular dysrhythmias

Question 11

Adult TCA OD - Sodium Bicarbonate contraindication?

Answer 11

None when used in emergency situations
Excessive chloride loss
Alkalosis
Hypocalcemia

Question 12

Adult TCA OD - Sodium Bicarbonate precautions?

Answer 12

Use with caution in CHF, severe renal impairment, concurrent corticosteroid treatment
Avoid extravasation

Question 13

Adult TCA OD - Magnesium sulfate indications?

Answer 13

TCA OD with ventricular dysrhythmias

Question 14

Adult TCA OD - Magnesium sulfate dose?

Answer 14

2 g IV/IO in 50 mL NS over 5 min

Question 15

Adult TCA OD - Magnesium sulfate contraindications?

Answer 15

Any degree of heart block

Renal failure

Question 16

Adult TCA OD - Magnesium sulfate precautions?

Answer 16

Monitor for respiratory depression