Tricyclic Antidepressant Overdose
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First Things First (assess for and treat the following)
- ABCs are priority!
- Mental status may deteriorate; pts may need intubation.
- Cardiovascular monitoring for and treatment of life-threatening ventricular arrhythmias
- Refractory hypotension is the most common cause of death in TCA overdose; IV fluid resuscitation should be initiated and adequate IV access obtained.
- Activated charcoal should be administered for decontamination.
- Alkalinization with sodium bicarbonate is a cornerstone of therapy, especially if QRS >100 ms and pt has wide complex tachycardia or hypotension.