TCA overdose — MCCQE Part 1 MCQ

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HardPoisoning/OverdoseTCA overdoseMCCQE Part 1

A 35-year-old woman found unconscious with empty amitriptyline blister packs. GCS 8. ECG: QRS 160ms, right axis, sinus tachycardia 130. Most important immediate treatment?

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Correct answer: A — IV sodium bicarbonate

TCA OD: QRS >160ms = ventricular arrhythmia risk. IV NaHCO3 overcomes Na channel blockade. Flumazenil contraindicated (seizure risk). Intubate for GCS 8. ICU admission.

Reference: Canadian Poison Centres / Toxicology