Please refer to TOXBASE for definitive recommendations, however as a quick reference:
1. Gastric decontamination
a. For patients presenting within 1 hour, particularly for modified release preparations, gastric lavage (in those with skills to do so), and/or activated charcoal.
b. Multi-dose activated charcoal for late presentations of modified release agents.
c. Consider whole-bowel irrigation with modified release agents.
a. Treat with IV atropine (titrate to response)
b. Consider IV dobutamine, isoprenaline
c. Temporary pacing.
a. IV fluid bolus of 0.9% NaCl 20 mls/kg
b. IV calcium chloride or IV calcium gluconate as a slow bolus
c. IV Insulin & dextrose therapy as second-line agent.
d. For treatment resistant cases, Intralipid may prove of benefit if the above measures fail e. Consider IV inotropes, and/or mechanical means of blood pressure support.
4. Cardiac Arrest
a. For in-hospital, or witnessed cardiac arrest with immediate CPR, resuscitation should be continued for at least 1 hour.
IV calcium therapy is used to temporarily restore blood pressure Repeat doses (maximum 4), or an infusion may be required.
IV insulin & dextrose therapy (High Dose Insulin Euglycaemic Therapy, HIET) has been used successfully to restore cardiac function, and reverse hypotension in beta-blocker and CCB overdose, and is considered superior to inotropes for treatment resistant cases. HIET may be administered peripherally, reducing the time necessary to initiate treatment, but it may be up to 15 minutes for clinical effect to become apparent.