A 30 year old female is brought to your ED by ambulance following a suspected drug overdose.
a. Describe and interpret her ECG (50%) b. Outline your initial management in the ED. (50%)
FACEM VAQ Exam 2006.1 – Question 1
- The overall pass rate for this question was 30/40 (75%).
- The ECG given shows a broad complex tachycardia
- Examiners expected that the ECG description would specify the rate of 130, broad QRS and prolonged QT likely to be TCA overdose (or other Na channel blocking agent).
- Initial management needed to focus on the need for bicarbonate/alkanisation and a low threshold for definitive airway management because of the high risk of rapid deterioration.
- Failing answers misinterpreted the ECG, including being unable to estimate the rate. Some missed the clues about a toxicological cause and assumed this was a primary cardiac problem.
- Others did not mention TCAs as a possible cause and saw no role for the use of bicarbonate.
See also: Toxicology Conundrum #022