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Tricyclic overdose — DipIMC MCQ

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HardMedical EmergenciesTricyclic overdoseDipIMC

A 27-year-old is found drowsy after an overdose of amitriptyline. He is hypotensive and the ECG shows QRS widening with ventricular ectopy. What is the most appropriate drug/dose?

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Correct answer: BGive sodium bicarbonate according to toxicology guidance

Give sodium bicarbonate according to toxicology guidance is the best answer because TCA overdose with QRS widening and hypotension is treated with sodium bicarbonate. Give oral antihistamine as first-line treatment is less appropriate because antihistamines do not treat airway, breathing or circulation compromise; Give intramuscular adrenaline 1 mg is less appropriate because 1 mg intramuscular adrenaline is not the standard anaphylaxis dose. Give intravenous adrenaline 1 mg as a rapid bolus and Delay medication until hospital review are also suboptimal because they move attention away from the key pre-hospital priority.. The key DipIMC principle is to treat immediate reversible threats, communicate clearly and move the patient toward the right definitive care.

Reference: TOXBASE/NPIS guidance; JRCALC Guidelines; Resuscitation Council UK Guidelines