Template:Anticholinergic Toxicity Treatement: Difference between revisions
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***Side effects: bradycardia, dysrhythmias, cholinergic excess | ***Side effects: bradycardia, dysrhythmias, cholinergic excess | ||
***Always have [[atropine]] at the bedside for bradycardia or cholinergic excess | ***Always have [[atropine]] at the bedside for bradycardia or cholinergic excess | ||
***'''Contraindicated''' in [[TCA toxicity]] (associated with cardiac arrest) | ***'''Contraindicated''' in [[TCA toxicity]] (associated with cardiac arrest) and in the presence of bradycardia or AV block | ||
Revision as of 12:16, 1 September 2019
Treatment
- Consider GI decon with Activated Charcoal
- Sedation
- Decreases the risk of hyperthermia, rhabdo, traumatic injuries
- Benzos are agents of choice especially increase seizure threshold
- Sodium bicarbonate for conduction abnormalities (QRS prolongation)
- 2 mEq/kg bolus (typically 2-3 amps of bicarb)
- Begin continuous NaCO3 infusion at 250mL/hr if bolus effective
- Solution preparation = 1L D5W mixed with 3 ampules NaHCO3
- Cholinesterase inhibition
- Indicated for severe agitation or delirium (esp if unresponsive to benzos)
- Contraindicated in QRS>100 or Na blockade signs (R' in aVR)
- Relatively contraindicated in asthma or ileus
- Physostigmine - strongly consider poison control consult before giving
- Crosses blood brain barrier, can be used to help make dx
- Dosing: 0.5-2mg IV over 5min
- Onset of action: 15-20min
- Side effects: bradycardia, dysrhythmias, cholinergic excess
- Always have atropine at the bedside for bradycardia or cholinergic excess
- Contraindicated in TCA toxicity (associated with cardiac arrest) and in the presence of bradycardia or AV block