People often remark to me, 'Wah working in emergency department must be very exciting! I bet you gets to see lots of gory injuries and things people 'accidentally' stick up their various orifices!'

Don't worry, you won't be seeing any of those. :)

What you WILL see, however, are interesting photos, ECGs, Xrays etc. which serve to remind us of the vast variety of cases that may come our way, and some of the learning points behind them.

Enjoy. :)

Monday, May 23, 2011

Case 12

22 year old female brought in semi-conscious by boyfriend.

BP 90/60, HR 150/min.
Hypocount : 5.2 mmol

10 minutes later she developed a generalized tonic-clonic seizure.

What does the ECG show?
What is the likely underlying cause?

Answer : Tricyclic Antidepressant (TCA) Overdose

The ECG shows a broad-complex tachycardia which raises the suspicion of a VT (ventricular tachycardia). This is unusual in a young female patient, as VT usually occurs in the setting of more elderly patients with underlying cardiac disease.

Involvement of the cardiovascular and neurological systems in a young patient who presents with in this manner (brought in by boyfriend) should alert us to the possibility of a drug-overdose, especially that of tricyclic antidepressants (TCA) such as amitriptyline.

Presenting features of TCA toxicity may include:

Cardiovascular : Palpitation, Chest pain,  Hypotension
CNS : Convulsion, Decrease mental status, Respiratory depression, Drowsiness, Coma
Peripheral autonomic system : Dry mouth, Dry skin, Urinary retention, Blurred vision

·        ICU management
·        Support airway and vital signs
·        Activated charcoal for GI decontamination
·        IV Sodium Bicarbonate esp. in prolonged QRS
·        Benzodiazepines for seizures
·        Consider hemodialysis

1 comment:

  1. This website is absolutely fascinating! Doesn't look like you've posted in a long time... why not? I'm not in the medical profession, but I love the study of medicine, and find this to be very interesting. On this particular EKG, I thought it might be a drug overdose. I was surprised to find I was right, and further surprised to discover that you can tell what KIND of overdose?! very interesting.