Thank you! I shared this with my Paramedic class during our Toxicology section. It always seems to be a testable question and is very relevant when you find that OD patient with a WIDE QRS. Thanks Again!!
It's probably important to note you do NOT have to wait for QRS widening to treat for TCA OD, but **IF** you have a history or report suspicious of TCA ingestion, AND tachycardia AND Hypotension/borderline hypotension, you should not wait for QRS changes or seizures. Tachycardia and hypotension often precede QRS widening. Also, TCAs are actually bases, not acids, so they do not directly cause acidosis, any acidosis is from respiratory depression and/or other ingestions. The use of Bicarb is for sodium loading instead. therefore normoventilation parameters should resolve any respiratory acidosis in due order and "chasing" the ETCO with hyperventilation is ill advised. While acidosis is bad and worsens TCA binding, trying to cause widespread metaboolic changes with respiratory interventions is challenging and often counterproductive, even dangerous. For ex, hyperventilation can cause hypotension via increased intrathoracic pressure, and in the already hypotensive patient this is a bigger danger. Instead, aim for normal ventilation settings unless there are other indications, and treat with bicarb and other antiarrhythmics (no amiodarone or procainamide) as needed until you have labratory values to guide interventions. Respectfully submitted.
@@allthingsparamedic I've been getting dosed with TCA against my will. I was given a HUGE amount, the room was spinning, and I was vomiting a lot, so my son called 911. My blood was tested. The P.A. who was caring for me asked if I take any psych meds. I said, "no, why?" He didn't answer, left the room, and returned with a syringe. I asked what he was about to inject me with. He told me it was Ativan. I said, "why are you giving me a benzo?" He said, "it'll make you feel better." He was right, it did, and it only took about 15 min. *QUESTION: How long does it take for a dose of TCA to make one feel sick like this?* Thanks in advance if you're able/willing to reply. EDIT: I realized it was TCA because I took an OTC drug test. The hospital staff was pointless...
I took 12 pills at once about 7 months ago and I saw black and falled asleep when I wake up my head was hurting me.. I didnt tell the doctor. Do u think the pills will affect my health in the future? What can I do?
@@georgianamihaila7145 I'll say a prayer for you, sweetheart. Have you maintained your sobriety since you posted your comment? Hope all is well with you. 😊
The medication that they od on will depend if a 12 lead is necessary. Only if I think there is a possibility of a AMI. A cocaine overdose may indicate a need for a 12 lead ECG
I'm very sorry about your loss. Doxepine is a TCA. I'm not aware of the situation, so I can't comment on what might have happened. Acute toxicity would imply she had too much too quickly.
I'm very sorry you lost your best friend, Melanie. How are you holding up now? I see it's been 2 years. I hope your heart has begun to heal a little since they passed. Take care, love.
Great. Finally I find paramedic
Thank you! I shared this with my Paramedic class during our Toxicology section. It always seems to be a testable question and is very relevant when you find that OD patient with a WIDE QRS. Thanks Again!!
Epic, thanks for the share. I would be happy to create more content on topics that would be helpful. Feel free to suggest.
It's probably important to note you do NOT have to wait for QRS widening to treat for TCA OD, but **IF** you have a history or report suspicious of TCA ingestion, AND tachycardia AND Hypotension/borderline hypotension, you should not wait for QRS changes or seizures. Tachycardia and hypotension often precede QRS widening.
Also, TCAs are actually bases, not acids, so they do not directly cause acidosis, any acidosis is from respiratory depression and/or other ingestions. The use of Bicarb is for sodium loading instead. therefore normoventilation parameters should resolve any respiratory acidosis in due order and "chasing" the ETCO with hyperventilation is ill advised. While acidosis is bad and worsens TCA binding, trying to cause widespread metaboolic changes with respiratory interventions is challenging and often counterproductive, even dangerous. For ex, hyperventilation can cause hypotension via increased intrathoracic pressure, and in the already hypotensive patient this is a bigger danger.
Instead, aim for normal ventilation settings unless there are other indications, and treat with bicarb and other antiarrhythmics (no amiodarone or procainamide) as needed until you have labratory values to guide interventions.
Respectfully submitted.
Always appreciated, thank you.
@@allthingsparamedic I've been getting dosed with TCA against my will. I was given a HUGE amount, the room was spinning, and I was vomiting a lot, so my son called 911. My blood was tested. The P.A. who was caring for me asked if I take any psych meds. I said, "no, why?" He didn't answer, left the room, and returned with a syringe. I asked what he was about to inject me with. He told me it was Ativan. I said, "why are you giving me a benzo?" He said, "it'll make you feel better." He was right, it did, and it only took about 15 min.
*QUESTION: How long does it take for a dose of TCA to make one feel sick like this?* Thanks in advance if you're able/willing to reply.
EDIT: I realized it was TCA because I took an OTC drug test. The hospital staff was pointless...
Are these effects the same for the tetracyclic’s class of drugs as for the tricyclic’s? I can’t find any info on them separately from the tricyclics.
What can happen if you cold turkey clomipramine?
I took 12 pills at once about 7 months ago and I saw black and falled asleep when I wake up my head was hurting me.. I didnt tell the doctor. Do u think the pills will affect my health in the future? What can I do?
Probably not an issue moving forward. Just take care of yourself.
@@allthingsparamedic i rlly hope I will have no problems in the future cuz what I ve done
@@georgianamihaila7145 I'll say a prayer for you, sweetheart. Have you maintained your sobriety since you posted your comment? Hope all is well with you. 😊
Would you consider 12 leads/EKG evaluation on every OD patient even if he or she woke up after administration of naloxone?
The medication that they od on will depend if a 12 lead is necessary.
Only if I think there is a possibility of a AMI.
A cocaine overdose may indicate a need for a 12 lead ECG
@themedguy my best friend recently passed away from acute toxicity of doxapine. How would that happen?
I'm very sorry about your loss.
Doxepine is a TCA.
I'm not aware of the situation, so I can't comment on what might have happened.
Acute toxicity would imply she had too much too quickly.
I'm very sorry you lost your best friend, Melanie. How are you holding up now? I see it's been 2 years. I hope your heart has begun to heal a little since they passed. Take care, love.
👍
Thank you for the encouragement
🖤🖤🖤🖤🤍