Tox: Beta Blocker OD

T car Beta Blockers
si/sx
-bradycardia, hypotn, chf, ams, sz
-EKG - QRS widening (propranolol), sotalol may cause QT prolong, vtach, torsades, vfib

Rx:
-vitals, O2, monitor, IV access, EKG
-labs-lytes, bun, cr, glc, abg (acid-base)
-gastric lavage if <1-2hr
-activated charcoal 1g/kg
0) NS bolus 20cc/kg; if bp<90 then
1) glucagon 50 mic/kg IV bolus (.05mic/kg), repeat as necessary
-if any inc in bp after bolus, do infusion at 75mic/kg/h, if bp<90 after 5 min, inc to 150mic
-no change in bp after 5 min from initial bolus, give 100mic/kg bolus, wait 5 min
-don't mix glucagon in the supplied diluent (phenol-sz, hypotn, dysrhyth)), use ns
2) dopamine 5mic/kg/min if <90 inc by 5mic/kg/min q 5min up to 20
3) norepi .5mic/min, inc .5mic/min q5min up to 4.0mic/min
-give 5min for each change in rx to work
-For sotalol, give lidocaine, mgso4, isoproterenol and overdrive pacing for dysrhythmias

Dispo:
-sx can be delayed to 10 hr
-if asx after 8-10h with normal repeat EKG, may be cleared