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Tricyclic antidepressant overdose — MCCQE Part 1 MCQ

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HardPoisoning/OverdoseTricyclic antidepressant overdoseMCCQE Part 1

44-year-old man presents with collapse after overdose. ECG shows QRS widening and hypotension. Which of the following is the most appropriate next step?

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Correct answer: D — Give IV sodium bicarbonate and supportive critical care

Give IV sodium bicarbonate and supportive critical care is best because wide QRS and hypotension after TCA overdose require sodium bicarbonate. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. QRS duration guides risk and treatment response.

Reference: Canadian poison centre guidance