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Tricyclic antidepressant cardiac arrest — DipIMC MCQ

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HardResuscitationTricyclic antidepressant cardiac arrestDipIMC

A 30-year-old woman is found collapsed after a tricyclic antidepressant overdose. She has a broad-complex tachycardia, hypotension and then loses a central pulse. What is the most appropriate drug/dose?

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Correct answer: A — Sodium bicarbonate 50 mmol IV with ALS for suspected sodium-channel blockade

Tricyclic antidepressant toxicity causes sodium-channel blockade, broad QRS rhythms and cardiovascular collapse; sodium bicarbonate is the specific early treatment alongside ALS. Adenosine is inappropriate for toxic broad-complex cardiovascular collapse. Amiodarone may worsen conduction toxicity and is not the antidote. The pearl is that overdose arrests require toxidrome recognition during resuscitation.

Reference: JRCALC Guidelines 2025; Resuscitation Council UK Special Circumstances Guidelines 2025