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.