Moderator EMEDPA Posted November 6, 2017 Moderator Share Posted November 6, 2017 great case tonight. elavil OD. walked in 90 min after OD. picked the wrong drug to try their suicidal gesture with. it turns out 8000 mg of elavil is not a trivial OD as most of you know. intubated 10 min later and placed on bicarb drip. doing ok in icu. love these cases. watched qrs widen before bicarb then narrow with push and infusion. had some of these cases as a medic that I saw much later in their course who had protracted cardiac arrest/resuscitations. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 6, 2017 Author Moderator Share Posted November 6, 2017 1 day f/u. still intubated and pretty obtunded. no ongoing sedation requirements for vent management and responding only to painful stimuli. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 7, 2017 Author Moderator Share Posted November 7, 2017 apparently doing much better today. fighting the vent and requiring sedation. plan is for trial of extubation tomorrow. Link to comment Share on other sites More sharing options...
jmj11 Posted November 7, 2017 Share Posted November 7, 2017 This was the drug of choice of a previous SP, who attempted to take her own life. It wasn't pretty. For several days we didn't think she was going to make it. I don't know what her dose selection was, but the "whole bottle." Link to comment Share on other sites More sharing options...
JoeM Posted November 7, 2017 Share Posted November 7, 2017 just push bicarb until the QRS normalizes! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 8, 2017 Author Moderator Share Posted November 8, 2017 pt has been on a bicarb drip x 2 days after several amps pushed initially. looks like they will probably make it at this point with plan to extubate in am. Link to comment Share on other sites More sharing options...
kargiver Posted November 10, 2017 Share Posted November 10, 2017 I'm amazed to see that it is even still prescribed! Love TCA ODs... G Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 10, 2017 Author Moderator Share Posted November 10, 2017 yup, great case. Have had several over 30 years in em, but this was probably the best as I got to see it evolve. The pt ended up doing ok. They were extubated without deficits and now are a med/surg pt awaiting psych placement.... Link to comment Share on other sites More sharing options...
narcan Posted November 27, 2017 Share Posted November 27, 2017 On 11/10/2017 at 6:43 AM, kargiver said: I'm amazed to see that it is even still prescribed! Love TCA ODs... G It certainly is out of favor for routine depression treatment, as SSRI's are much safer, but it's making a comeback with the need to reduce opiate usage in chronic pain. It's got good indications for post-herpetic neuralgia and migraine prophylaxis, probably others I'm not thinking of, and it helps with sleep and chronic pain. Link to comment Share on other sites More sharing options...
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