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Propranolol overdose — SCE Acute Medicine MCQ

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ModerateToxicology and OverdosePropranolol overdoseSCE Acute Medicine

A 34-year-old woman presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show bradycardia, shock, hypoglycaemia and broad-complex ECG changes. What is the most appropriate next step in management?

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Correct answer: B — Give glucagon and seek toxicology advice for high-dose insulin therapy

The key discriminator is that bradycardia, shock, hypoglycaemia and broad-complex ECG changes, which makes Give glucagon and seek toxicology advice for high-dose insulin therapy the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Call critical care for escalation would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Start anticoagulation after assessing bleeding risk are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; BNF