03.01.2021 - By Zack Olson, MD and Michael Estephan, MD
CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
You are working a shift at EM Clerkshift General when you are called to the resuscitation bay to see an elderly patient with unstable vitals brought in by EMS.
Initial Vitals
* Temp 98.0F* HR 43* RR 18* BP 60/40* O2 98%
Critical Actions
* Diagnose the etiology for the bradycardia (BB overdose)* Administer Atropine* Administer Glucagon* Administer Epinephrine drip* Attempt transcutaneous/transvenous pacing* Administer high-dose Insulin therapy
Final Diagnosis
Beta Blocker Overdose
Tips and Tricks
* Keep in mind the broad differential for severe bradycardia – ischemia, ingestion, electrolyte abnormalities, intrinsic arrhythmia/heart block, hypothyroidism, hypothermia, hypoglycemia, hypoxia, increased intracranial pressure, neurogenic shock.
Further Reading
High Dose Insulin Therapy (EMCRIT)
Low and Slow Poisoning (EMCASES)