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Tricyclic antidepressant overdose — RCPSC EM MCQ

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HardToxicologyTricyclic antidepressant overdoseRCPSC EM

A 45-year-old man is found confused beside an empty amitriptyline bottle. Blood pressure is 86/44 mmHg, QRS is 156 ms, terminal R wave is present in aVR, and pH is 7.22. What is the most appropriate investigation?

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Correct answer: E — Serial ECG assessment of QRS and aVR changes

In tricyclic antidepressant poisoning, ECG findings guide severity and sodium bicarbonate therapy more rapidly than serum drug levels.

Reference: Ontario Poison Centre guidance; Goldfrank toxicology principles