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MP10 CYCLIC ANTIDEPRESSANT OVERDOSE

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					MP10 CYCLIC ANTIDEPRESSANT OVERDOSE

      Basic Life Support

      Primary Survey:
           Perform ABC’s.
           Suction secretions, as needed and turn patient on their side to maintain proper airway
              management if required.
           Administer oxygen.
           Maintain airway support if needed using BVM.
           Initiate cardiac monitoring and obtain a rhythm strip if trained to do so.
           Prepare for cardiac arrest.
           Administer a five teaspoons (25 grams) of activated charcoal and water if the patient is
              conscious with an intact gag reflex.
           Do not induce vomiting.
           Because of the potential toxicity of the cyclic antidepressants, all overdose patients must
              be transported to health care facility.

      Advanced Life Support

      The EMT-A/Paramedic may proceed as follows:

             Start IV enroute to hospital with normal saline on all patients with a history of ingestion of
              >500 mg in adults or 10 mg/kg in children.

      B. REQUIRES DIRECT MEDICAL CONTROL

             Contact medical control to treat seizures according to protocol if they develop.
             For hypotension infuse normal saline to maintain blood pressure at 100 mmHg.


      The Paramedic may proceed as follows:

      A. DOES NOT REQUIRE DIRECT MEDICAL CONTROL

             If the QRS interval appears widened on the monitor obtain a strip and measure the QRS
              interval
             For seizure activity treat according to protocol

      B. REQUIRES DIRECT MEDICAL CONTROL
          If QRS interval > 0.10 seconds, administer 1 mEq/kg of sodium bicarbonate IV.

             Hypotension:
              a) administer Sodium Bicarbonate 1 mEq/kg IV while rapidly infusing normal saline.

             Ventricular arrhythmias.
              a) PVCs: Treat as per protocol only if present in conjunction with symptoms of ischemic
                 heart disease.
              b) V - Tachycardia:If hemodynamically stable, administer sodium bicarbonate 1 mEq/kg
                 IV.
              c) Pulseless Ventricular Tachycardia and Ventricular Fibrillation: Defibrillate
                 immediately, followed by the administration of sodium bicarbonate 1 mEq/kg as soon
                 as an IV is established.

             Hemodynamically unstable bradyarrhythmias:
               Treat with transcutaneous pacing; and
               If the patient is intubated, hyperventilate in conjunction with the intravenous
                administration of sodium bicarbonate.

Saskatchewan Emergency                                          MP10 CYCLIC ANTIDEPRESSANT OVERDOSE
Treatment Protocols                                                                           Revised July 2009
MP10 CYCLIC ANTIDEPRESSANT OVERDOSE


      SPECIAL CONSIDERATIONS:

          1. Sodium bicarbonate is not indicated in non-cyclic antidepressant overdoses.
          2. Sodium bicarbonate cannot be given via an endotracheal tube.
          3. In cases of cyclic overdose, if CPR has been initiated, it should be continued until a health
             care facility is reached.
          4. Asymptomatic patients with normal QRS width and no ventricular arrhythmias do not
             require sodium bicarbonate IV.

      When in a service area where EMT-A or Paramedic service is available, if the patients condition
      deteriorates, arrange an ALS intercept.




Saskatchewan Emergency                                        MP10 CYCLIC ANTIDEPRESSANT OVERDOSE
Treatment Protocols                                                                        Revised July 2009

				
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