Pediatric TCA OD

Question 1

Pediatric TCA OD - Initial actions?

Answer 1

Vascular access
If hypotensive 20 ml/kg bolus total max 40 ml/kg
12-lead

Question 2

Pediatric TCA OD - Signs of cardiotoxicity?

Answer 2

Refractory hypotension
QRS > 0.10
Ventricular dysrhythmia

Question 3

Pediatric TCA OD - Signs of cardiotoxicity treatment?

Answer 3

Sodium Bicarbonate 1 mEq/kg q 5 min prn

Question 4

Pediatric TCA OD - After bicarb pt seizing treatment?

Answer 4

Treat concurrently with seizure protocol - midazolam

Question 5

Pediatric TCA OD - Ventricular dysrhytmia refractory to bicarbonate?

Answer 5

Magnesium Sulphate 25 mg/kg single max 2 g in 50 ml over 20 min

Question 6

Pediatric TCA OD - Sodium Bicarbonate indications

Answer 6

Symptomatic TCA OD

Question 7

Pediatric TCA OD - Sodium Bicarbonate dose

Answer 7

1 mEq/kg SIVP/IO

q 5 min prn until signs of cardiotoxicity resolved

Question 8

Pediatric TCA OD - Sodium Bicarbonate EMS contraindications

Answer 8

Excessive chloride loss Alkalosis

Hypocalcemia

Question 9

Pediatric TCA OD - Sodium Bicarbonate precautions

Answer 9

CHF, severe renal impairment, concurrent corticosteroid treatment
Avoid extravasation due to the risk of tissue necrosis

Question 10

Pediatric TCA OD - Magnesium Sulphate indications

Answer 10

Tricyclic antidepressant overdose with ventricular dysrhythmias

Question 11

Pediatric TCA OD - Magnesium Sulphate dose

Answer 11

25 mg/kg IV/IO to a single max of 2 g

dilute in 50 mL NS over 20 minutes

Question 12

Pediatric TCA OD - Magnesium Sulphate EMS contraindications

Answer 12

Any degree of heart block

Renal failure

Question 13

Pediatric TCA OD - Magnesium Sulphate precautions

Answer 13

Monitor for respiratory depression