Overdose: TCA Antidepressants (Paediatric)

Status
Suspected TCA overdose
Assess
• Substance involved • Perfusion status • ECG criteria
Are there any of the following:
• Less than adequate perfusion • QRS >0.12 sec. (>0.16 sec. indicates severe toxicity) • QT prolongation (>1/2 R-R interval)

No No toxicity BLS Consider potential to develop signs of toxicity

Yes   Signs of TCA toxicity Sodium Bicarbonate 8.4% 2ml/kg IV, given over 3 minutes - Repeat 2ml/kg IV after 10 minutes if signs of toxicity persist - Severe cases may require continuing doses - Consult Consider Intubation if required - Hyperventilate with 100% O2 - rate 20-24bpm - EtCO2 target 20-25mmHg if intubated

Special Notes

ECG changes ECG changes include prolonged PR, QRS and QT intervals associated with an increased risk of seizures if QRS >0.10 sec. and ventricular arrhythmias if QRS >0.16 sec. How to measure a QT interval is shown below.