Acute

Question 1

TCA OD

Name the effects and presentation

Answer 1

Amitryptiline and dosulepin

Anticholinergics: dry mouth, dilated pupils, agitation, tachycardia, blurred vision
Complications: arrhythmias, seizures, metabolic acidosis, coma
ECG: sinus tachycardia widened QRS long QT

Question 2

Managing a TCA OD

Answer 2

Iv bicarbonate - if seizures and tachyarrythmias NOT ANTIARRYTHMICS- correct acdicosis first then the arrhythmia

Get ECG FIRST

Question 3

Managing diazepam overdose

Answer 3

Flumazenil- respiratory depression

Question 4

Paracetamol OD

Answer 4

Activated charcoal
- if >10mg ingested (or >200mg/kg) < 2hrs ago

Acetylcysteine-

• If staggered overdose(taken >1hr)or unsure about timing.
• If paracetamol concentration is above 100mg at 4hrs or 15mg at 15hrs. See graph. As little as 150mg/kg in 24hrs can be fatal.

Give over 1 hour.

Question 5

When to give a liver transplant in paracetamol OD

Answer 5

Arterial ph <7.3 24hrs post ingestion
Or any of:
- prothrombin time >100s
- creatinine >300 u mol/l
- grade 3/4 encephalopathy