TCA in overdose produce symptoms due to their:
- anticholinergic effects (dry mouth, dilated pupils, tachycardia, constipation, urinary retention, raised intraocular pressure)
- alpha blockade (hypotension)
- sodium channel blockade (my personal favourite, cardiac arrhythmias)
On the ECG look out for:
- long PR
- wide QRS
- long QT
In terms of managing these patients you need:
- ECG and cardiac monitoring
- consider charcoal if <2 hrs post ingestion
- bloods for UEs and paracetamol and salicylate (always assume paracetamol taken until proven otherwise)
- ABG
- fluids if needed to support BP
- if acidotic - bicarb
- dialysis is NOT indicated
- avoid class Ia/Ic/III antiarrythmics as they all prolong QT. Also avoid flumazenil (also prolongs QT)
- observe
Thats all for today folks, and I'm taking tomorrow off. And possibly the day after too, depending on my mood. But battles will definitely recommence on Monday.
