DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
A woman with an anxiety disorder is on alprazolam, and imipramine. She is brought to the ER for a multiple drug overdose. Her daughter states that she may have taken about 30-40 tablets of 50 mg imipramine, and 35-40 tablets of 1 mg alprazolam. On route to the hospital she became apneic and was intubated. Her BP is 140/84 pulse is 120, and she is unresponsive to painful stimuli, and her pupils react very sluggishly. There are no other neuro findings. The ECG shows a normal sinus rhythm with a widened QRS complex. Which of the following is the most appropriate intervention.
A. DC cardioversion
B. Flumazenil
C. Ipecac
D. Lidocaine bolus
E. Mainenance of serum pH at 7.5
What is the antidote for Benzodiazapine OD? And when would you use it and when would you NOT use it (because it would be dangerous) HOW is it dangerous?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
Antidote for BDZ is Flumazenil and it should be cautiously used to precent SEIZURES.
In this case, I am thinking of TCA overdose with widened QRS due to acidosis...May be we should increase the ph to 7.5?
|
| CocaCola
Forum Guru
Topics: 35
Posts: 907
|
dont use flumazenil when you have a TCAand benzo OD... reversing the effects of the benzo with flumanzanil will uncover the effects of the TCA leading to seizures
___________________
There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can give all our attention to the opportunity before us!!!
|
| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
|
I agree with coca cola.
|
| dr in trouble
Forum Guru
Topics: 62
Posts: 610
|
We cannot use ipecac bcoz pt is intubated otherwise the best step is to give ipecac but here i will go with option E.
___________________
If u want to do something, do it today as there is no tomorrow.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
E is right.
QT Prolongation or QRS widening- you should suspect TCA OD.
Treatment: Maintain alkalemic state by hyperventilation if the patient is intubated or with IV bicarbonate.
Gastric aspiration and lavage should be performed to eliminate unabsorbed drug if more than 750 mg of TCA has been taken.
Seizures can occur in TCA OD but the patient also took a Benzo, which is probably supressing the seizures.
Flumazenil might reverse the effects of the benzo, and might cause life threatening seizures.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
So, WHEN is Flumazenil the RIGHT choice in case of Benzo OD?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| dr in trouble
Forum Guru
Topics: 62
Posts: 610
|
When pt took benzodiazepines alone.
___________________
If u want to do something, do it today as there is no tomorrow.
|
| ssrpk
Forum Fanatic
Topics: 154
Posts: 2,819
|
how will hyperventilation help?
___________________
life is guud
|
| ssrpk
Forum Fanatic
Topics: 154
Posts: 2,819
|
i mean raising the pH ... enhancing urinary trapping???
___________________
life is guud
|
|
| |
| | | | | | | | | | |
Similar forum topics