S15C188 - BB OD

Question 1

BB: pharmacology

Answer 1

• decrease intracellular Ca, modulate contractility of myocyte and smooth muscle
• Na channel blockade

Question 2

BB OD: clinical picture

Answer 2

• bradycardia and shock primarily
• if BB with Na antagonism: wide complex brady, possible Sz
• sotalol: (block K channel), prolongs QT, ventricular dysrhythmia (PVC, bigeminy, v tach/fib, torsades)
• AMS, coma, Sz
• bronchospasm (if nonselective)

Question 3

BB OD: Tx

Answer 3

• ABCD
• E - HD then ECMO
• fluid resusc
• glucagon
• adrenergic agonists (NE)
• insulin
• calcium
• phosphodiesterase inhibitors (milrinone) if glucagon not available
• sodium bicarb (if acidotic or wide QRS)

Question 4

BB OD: glucagon

Answer 4

• starts working in 1-2min, lasts 15min
• bolus dose: 0.05-0.15mg/kg (3-10mg usually)
• if effect seen from bolus then give infusion of 1-10mg/h
• may see tachyphylaxis occur
• SE: n/v

Question 5

BB OD: insulin

Answer 5

• start with 1unit/kg IV bolus and follow with infusion of 1 unit/kg/h
• give 0.5g/kg bolus of glucose with insulin, monitor regularly

Question 6

Sotalol OD

Answer 6

-in addition to standard BB OD, also give magnesium, lidocaine, and pacing may be effective