Good evaluation of the EKG and the segment intervals.Blood glucose checks (serial if long transport, especially in children).Multiple frequent documented re-assessments.Appropriate protocol selection and management.Quantity of medication or toxin taken (safely collect all possible mediations or agents).Early airway management in the rapidly deteriorating patient.Time of symptoms onset and time of initiation of exposure-specific treatment.Identification of possible etiology of poisoning.
Repeat evaluation and documentation of signs and symptoms and vital signs as patient clinical conditions may deteriorate rapidly.9914215 – Medical-Beta Blocker Poisoning/Overdose.Frequent reassessment is essential as patient deterioration can be rapid and catastrophicĪssociated NEMSIS Protocol(s) (eProtocol.01).Sotalol can produce increase in QTc interval and ventricular dysrhythmia.Certain beta blockers, such as acebutolol and pindolol, may produce tachycardia and hypertension.Certain beta blockers, such as acebutolol and propranolol, may increase QRS duration.Propranolol crosses the blood brain barrier and can cause altered mental status, seizure, and widened QRS similar to TCA toxicity.Atropine may have little or no effect (likely to be more helpful in mild overdoses) – the hypotension and bradycardia may be mutually exclusive and the blood pressure may not respond to correction of bradycardia.Glucagon has a side effect of increased vomiting at these doses and ondansetron prophylaxis should be considered.It is very important that a careful assessment of medications the toddler could have access to is done by EMS and all suspect medications should be brought into the ED Pediatric patient may develop hypoglycemia from beta blocker overdose therefore it is important to perform glucose evaluation.Do not administer activated charcoal to any patients that may have a worsening mental status Aspiration of activated charcoal can produce a patient where airway management is nearly impossible.Transcutaneous pacing may not always capture nor correct hypotension when capture is successful.
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