Paeds Cases · acute-care-resuscitation-and-toxicology
Read the strip, choose the antidote — cardiotoxic and psychotropic medication poisoning
A bedside structured clinical encounter testing recognition of a child with a mixed cardiotoxic overdose, the reading of the ECG and the toxidrome, the choice of weight-based antidote (sodium bicarbonate for the tricyclic widened QRS, calcium and high-dose insulin euglycaemic therapy for the calcium channel blocker), the avoidance of the class Ia and Ic antiarrhythmic trap, the rescue role of lipid emulsion and extracorporeal support, communication, early escalation to retrieval, and safeguarding in parallel.
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This is one MedVellum formative structured clinical encounter. The scoring, prompts and performance descriptions are educational feedback tools. They are not an official college station, timing, mark allocation, pass score or reproduced examination format. The encounter assesses first-impression recognition of a calcium channel blocker toxidrome, the reading of the ECG and the bedside glucose, the choice of weight-based antidote, the avoidance of the sustained-release late-deterioration trap, communication, reassessment, early escalation to retrieval and extracorporeal support, and safeguarding in parallel. [3] [4]
References4ShowHide
- [2]Chan BS, Buckley NA Common pitfalls in the use of hypertonic sodium bicarbonate for cardiac toxic drug poisonings Clinical Toxicology (Philadelphia), 2024.PMID 38597366
- [3]Roperia V, Kiani AZ, Jayakumar N High-Dose Insulin Euglycemic Therapy in Concomitant Beta-Blocker and Calcium Channel Blocker Overdose Journal of Investigative Medicine High Impact Case Reports, 2025.PMID 40642834
- [4]Suarez F, Koyfman A, Long B Pearls and Pitfalls for the Emergency Clinician: Beta Blocker and Calcium Channel Blocker Toxicity Journal of Emergency Medicine, 2026.PMID 41833262
- [6]Nendumba G, Blackman S, De Lissnyder N, et al. Use of intravenous lipid emulsions in drug-induced toxicities: a 2025 narrative review Annals of Intensive Care, 2025.PMID 41247632