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Bouncebacks – Beta Blocker Overdose

Mike Weinstock, MD, Colin G. Kaide, MD, FACEP, FAAEM, UHM, and Sean Nordt, MD PharmD FAAEM
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19:57
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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02:45

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EM:RAP 2017 January Written Summary 926 KB - PDF

Most overdoses are not too challenging to great, in fact, most don’t even need an antidote. For patients with beta blocker OD, the opposite is true. They can require several different tactics to stabilize, and even when you’ve gotten to the end of your treatment pathway, they can still crash.

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Adam M., M.D. -

Last night I had a 20 yo female ingested unknown number of Propranolol 10 mg tablets (she said it was between 60-90 tab although I doubt it was that many) drive to my ER 2 hours post ingestion. Initially only mildly bradycardic and normotensive but I knew to start coordinating things early. She got Charcoal and Cal-gluconate early. Had Pharmacy make up an epi drip and bring it to the bedside,. Had the pharmacist call around to other hospitals to collect as much Glucagon as we could (only had a total of 10 mg in the Hospital (was able to secure an additional 20 mg before we needed it). Patient eventually became more bradycardic and hypotensive. Central line and epi drip supported her BP and Glucagon blue and drip with increased heart rate. Was WAY ahead of the game on this one. Was able to predict the course based on this segment. Segment was more helpful than the Poison control (although not blaming them). Intensivist didn't want the patient so we ended up managing her "Downstairs" until she stabilized to the point where the ICU felt comfortable taking her (on hospitalist service). Thanks all around for a GREAT segment on a fortunately rare OD. Printed up copies of the PDF to give to nurses taking care of this patient (was not a case any of them had ever seen). - Adam

Mike W. -

Adam, that is great to hear - thx for letting us know about this! Sounds like you did an awesome job... sort of funny, though, as it reminds me of the patients "too sick to see the doctor" - when your ICU does not want the pt because they are TOO critical - wow! Thx again for the comments and keep up the great work!!

Mike W. -

From Sean:
Hi Adam,
Great job with a complex case! Glad the EMRAP segment gave you a treatment approach and hopefully some peace of mind. Really appreciate the feedback!
Best regards,
Sean Nordt

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Broken Ankles, Ribs, and Pumps Full episode audio for MD edition 227:43 min - 318 MB - M4AEM:RAP 2017 January Canadian Edition Canadian 22:10 min - 31 MB - MP3EM:RAP 2017 January Australian Edition Australian 43:30 min - 60 MB - MP3EM:RAP 2017 January German Edition Deutsche 90:03 min - 124 MB - MP3EM:RAP 2017 January French Edition Français 32:33 min - 45 MB - MP3EM:RAP 2017 January Spanish Edition Español 65:46 min - 90 MB - MP3EM:RAP 2017 January Board Review Answers 220 KB - PDFEM:RAP 2017 January Board Review Questions 202 KB - PDFEM:RAP 2017 January Separate MP3 Files 265 MB - ZIPEM:RAP 2017 January Spanish Written Summary 1 MB - PDFEM:RAP 2017 January Written Summary 926 KB - PDF

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