• Approach to Calcium Channel Blocker Overdose

  • 2024/02/25
  • 再生時間: 26 分
  • ポッドキャスト

Approach to Calcium Channel Blocker Overdose

  • サマリー

  • Show Introduction

    • Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists.
    • Hosted by Dr. Pradip Kamat and Dr. Rahul Damania

    Case Presentation

    • A 14-year-old female with a history of depression and oppositional defiant disorder presents with dizziness, slurring speech, and is pale appearance.
    • The mother noticed symptoms of dizziness, stumbling, and sleepiness.
    • The patient had a prior suicide attempt.
    • Vital signs: HR 50 bpm, BP 75/40, GCS 10.
    • The initial workup reveals hyperglycemia, and she is stabilized and admitted to the PICU.

    Key Aspects of Ingestion Work-up

    • History and physical exam are crucial.
    • Stratify acute or chronic ingestions.
    • Consider baseline medications and coingestants.
    • Perform initial screening examination to identify immediate measures for stabilization.

    Diagnostic Studies

    • Pulse oximetry, continuous cardiac monitoring, ECG, capillary glucose measurement.
    • Serum acetaminophen, ASA levels
    • Consider extended toxicology screen.

    Differentiating CCB vs. Beta-Blocker Overdose

    • ECG findings: PR interval prolongation and Bradydysrhythmia suggest CCB poisoning.
    • Hyperglycemia in non-diabetic patients may indicate CCB overdose

    Approach to CCB Overdose

    • Initial resuscitation and stabilization
    • ABC approach
    • Consult Poison Control Center
    • Empiric use of glucagon, IV fluids, and vasopressors
    • Consideration of orogastric lavage and activated charcoal

    Specific Medical Therapies

    • Vasopressors: norepinephrine/epinephrine infusion
    • Atropine for bradycardia
    • IV calcium salts to overcome cardiovascular effects
    • High-dose insulin and dextrose for myocardial function
    • Investigational therapies: methylene blue, lipid emulsion

    Procedures

    • Transvenous pacemaker placement if needed
    • ECMO in refractory...
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あらすじ・解説

Show Introduction

  • Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists.
  • Hosted by Dr. Pradip Kamat and Dr. Rahul Damania

Case Presentation

  • A 14-year-old female with a history of depression and oppositional defiant disorder presents with dizziness, slurring speech, and is pale appearance.
  • The mother noticed symptoms of dizziness, stumbling, and sleepiness.
  • The patient had a prior suicide attempt.
  • Vital signs: HR 50 bpm, BP 75/40, GCS 10.
  • The initial workup reveals hyperglycemia, and she is stabilized and admitted to the PICU.

Key Aspects of Ingestion Work-up

  • History and physical exam are crucial.
  • Stratify acute or chronic ingestions.
  • Consider baseline medications and coingestants.
  • Perform initial screening examination to identify immediate measures for stabilization.

Diagnostic Studies

  • Pulse oximetry, continuous cardiac monitoring, ECG, capillary glucose measurement.
  • Serum acetaminophen, ASA levels
  • Consider extended toxicology screen.

Differentiating CCB vs. Beta-Blocker Overdose

  • ECG findings: PR interval prolongation and Bradydysrhythmia suggest CCB poisoning.
  • Hyperglycemia in non-diabetic patients may indicate CCB overdose

Approach to CCB Overdose

  • Initial resuscitation and stabilization
  • ABC approach
  • Consult Poison Control Center
  • Empiric use of glucagon, IV fluids, and vasopressors
  • Consideration of orogastric lavage and activated charcoal

Specific Medical Therapies

  • Vasopressors: norepinephrine/epinephrine infusion
  • Atropine for bradycardia
  • IV calcium salts to overcome cardiovascular effects
  • High-dose insulin and dextrose for myocardial function
  • Investigational therapies: methylene blue, lipid emulsion

Procedures

  • Transvenous pacemaker placement if needed
  • ECMO in refractory...

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