Crepitus
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45yo Male...Unconscious
- Thread starter Fox800
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I hate it when the patient fists his presentation!
Oh yeah coz you know we don't do takedowns anything like they do on COPS ... quick blast of midazolam and whoops he's a slobbering mess on the floor is not anywhere near as exciting as some Sheriff Deputies fighting with some guy and tazering his ***
R.O.P.
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Just wanted to say this is a great thread. Lots to think about- Thanks
RXMEDIC460
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bicarb
you could give sodium bicarb as an antidote for the Amytriptylene and prepare to tube it the bicarb doesnt help.
you could give sodium bicarb as an antidote for the Amytriptylene and prepare to tube it the bicarb doesnt help.
Large doses of sodium can be used for TCA overdoses; I don't know about sodium bicarbonate as in sufficent doses it could cause alkalosis.
Personally I think the best thing would be to put away our drug bag and take this guy to the hospital.
Smash
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Alkalosis is in fact exactly what we want to cause. Tricyclic antidepresssants (TCAs) bind about 7 times more strongly to proteins in the myocardium than in plasma in a normal environment and the binding increases in acidic environments. Alkalizing causes the binding to shift from the myocardium to plasma, whereby it can be metabolized and excreted. If intubating a TCA OD I'll blow off CO2 to below normal levels to allow for the same thing.
There is a common idea that increasing the availability of sodium ions somehow overcomes the sodium channel blockade. I'm not convinced of this: if the gate is shut, the gate is shut, in the same way that beta-blocker OD can't be overcome by administering beta-agonists but needs to have second messengers manipulated to cause inotropy and chronotropy from release of calcium from the sarcoplasmic reticulum.
However, despite the high likelihood of polypharm OD in this patient there are no obvious TCA specific signs, so I would question the use of NaHCO3. I would still manage airway, oxygenation and ventilation with intubation as opposed to trying to wake him though.