CodeBlue
Algorithms

Emergencies

TCA Overdose

Sodium channel blockade widens the QRS and causes arrhythmias and hypotension. Sodium bicarbonate is the antidote.

Interactive pathway
  1. Assess

    Recognize TCA toxicity

    • Anticholinergic toxidrome: tachycardia, mydriasis, dry skin, urinary retention
    • Rapid deterioration: seizures, coma, hypotension
    • ECG: QRS > 100 ms, terminal R in aVR > 3 mm, R/S in aVR > 0.7
  2. Action

    ABCs

    • Early intubation for ↓ consciousness; avoid hypoventilation (acidosis worsens toxicity)
    • Activated charcoal only if airway protected and early
    • Serial ECGs
  3. Decision

    QRS > 100 ms, ventricular arrhythmia, or hypotension?

Related EKGs

Sinus Tachycardia
Ventricular Tachycardia