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Norepinephrine/Epinephrine – Best choice with anecdotal evidence and case reports, titrate directly to effect.CatecholaminesĪt this point there is no clear winner for which pressor is best, but regardless you will need MUCH higher doses than you are used to giving. Symptomatic bradycardia requires immediate intervention. Transcutaneous pacing is frequently attempted but rarely effective. Due to decreased intracellular calcium, the voltage needed for pacing capture is much higher than typical. Aim for a rate 50-60 to allow increased repolarization time for intracellular calcium to accumulate. Severe nausea and vomiting – always give antiemetic with first dose to prevent potential airway emergencyĪtropine may be effective and there is no downside in trying. If effective, it will need frequent re-dosing or a drip given its short half life.ĭose: 0.5-1 mg in adults, 0.2 mg/kg in children Transcutaneous/Transvenous Pacing.It is reasonable to give 2 doses and, if efficacious, start drip at the effective dose – for example, if two 5 mg doses increased HR, then start a glucagon drip at 10 mg/hr. There is no defined therapeutic ceiling at this time. Re-bolus as needed every 10 minutes given short half life (~20 min).Initial dose: 5-10 mg IV and assess for efficacy.It also increases hepatic gluconeogenesis, counteracting the hypoglycemia caused by B2 blockade. This is the gold standard at this time, and is the “board answer” to treat beta blocker toxicities. Glucagon acts by directly increasing cardiac inotropy by activating adenyl cyclase by a secondary mechanism separate from that of catecholamines, bypassing beta blockade.metoprolol succinate) formulations even after the first few hours have elapsedĭO NOT delay airway or pharmacologic support to perform GI decontamination
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This consists of both gastric lavage, charcoal administration, +/- total bowel irrigationĬonsider these interventions in certain extended release (i.e.
BETA BLOCKER ANTIDOTE PLUS
Requirements are secure airway (either mental status or with an endotracheal tube) plus + compliant patient This is only indicated during first 1-2 hours of potentially fatal overdose After ABCs, have a member of the team contact local poison control and let them help guide your management. They also have the benefit of following as an inpatient to continue guidance.