ERDoc Posted July 11, 2007 Author Share Posted July 11, 2007 OK RTA = Rapid Trauma Assessment The H&H thing was just a joke for someone else on the forum disregard it If her GCS is so low how does she have a gag relex or am i picking nits Dude, if you are picking nits, you have much bigger problems than this lady's gag reflex. PM me and we'll set you up an appointment for treatment. :wink: Link to comment Share on other sites More sharing options...
Sdowler Posted July 11, 2007 Share Posted July 11, 2007 The EKG licks possibly like a right sided MI with depressions and QRS widening in I,AVL, V3,V,V6, also maybe a BBB Link to comment Share on other sites More sharing options...
ERDoc Posted July 11, 2007 Author Share Posted July 11, 2007 The EKG licks possibly like a right sided MI with depressions and QRS widening in I,AVL, V3,V,V6, also maybe a BBB OK, can't let it go. You've talked about licks and nits in you last few posts. We seriously need to talk. No harm intended Sdowler, just thought it was funny. Link to comment Share on other sites More sharing options...
Sdowler Posted July 11, 2007 Share Posted July 11, 2007 OK my spelling went to the toilet sorry Link to comment Share on other sites More sharing options...
chbare Posted July 11, 2007 Share Posted July 11, 2007 Sdowler, look at this patients presentation, medication list, then the 12 lead. Why are the QRS complexes wide? I am chomping at the bit to say my working diagnosis, but I will refrain. Take care, chbare. Link to comment Share on other sites More sharing options...
p3medic Posted July 11, 2007 Share Posted July 11, 2007 depression kills......time to shit or get off the pot Link to comment Share on other sites More sharing options...
chbare Posted July 11, 2007 Share Posted July 11, 2007 Indeed it can, especially in this case. However, I want some of the other members to research and come up with the answer on their own. Take care, chbare. Link to comment Share on other sites More sharing options...
northernmedic Posted July 11, 2007 Share Posted July 11, 2007 Wide complex QRS, tachycardia, hypotension, Elavil use. It definitely suggests one thing to me. Link to comment Share on other sites More sharing options...
mobey Posted July 11, 2007 Share Posted July 11, 2007 Alright I'll take a stab... If no one else will put themselves on the chopping block. Elavil is a tricyclic antidipressant, used to treat depression as well as some chronic pain. Signs of overdose include (but not limited to) Dysrhythmias, changes in QRS - width and axis. CNS depression, seizure, dialated pupils, vomiting, hypotension.... etc etc Management OPA/NPA for now tube as soon as she will tolerate it. 12 lead - continue 3 lead watch for dysrhythmias O2 IV TKO Transport rapid to ER If she wakes up Activated charcoal goes in...Otherwise gastric lavage in the ER. OK let me have it... Link to comment Share on other sites More sharing options...
chbare Posted July 11, 2007 Share Posted July 11, 2007 Now that somebody else answered, this is also my diagnosis. TCA's are harmful when overdosed by three general mechanisms. 1) Cardiac Toxicity: They block fast sodium channels and you can clearly see the effect in the 12 lead. You may see heart blocks and lethal rhythms develop. 2)Anticholinergic effects: You see the altered mentation, pupil changes (dilation), fever, and many other neurological effects. 3) Alpha blockade: Hypotension. My treatment would include: -Aggressive airway management. -Sodium bicarbonate therapy. -Supportive care and seizure precautions. -Possible initiation of vasopressors. (I think norepinephrine would be the med of choice related to it's strong alpha effects.) Take care, chbare. 3) Link to comment Share on other sites More sharing options...
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