Download Calcium Channel Blocker Poisoning

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Title
‘Toxicology On The Barrier’
Key learning objectives
Prehospital risk assessment in toxicology
Use of local resources/additional assistance to stabilize prior to transport
Management of life-threatening calcium channel blocker poisoning
Clinical scenario (information for participants)
A 67 year old man with a background of depression and hypertension has
presented to GP surgery on Great Barrier Island. Claims to have taken 60 x
120mg Diltiazem SR 3 hours ago. GP has called helicopter.
Handover: Heart rate and blood pressure were initially 70/min and 130/80, have
only just dropped to 48/min and 75/40. GCS15. GP has placed 16g IV cannula R
antecubital fossa and giving 1000mL N saline.
Equipment and Setup
Mannequin on stretcher, inside (surgery treatment area). 16g cannula R
antecubital fossa, 1000mL bag N saline hanging.
Can assume that additional medications/IV fluids ARE available in surgery Could
Consider extra person or the scenario facilitator playing the GP
Events occurring during scenario
Expectation is attempt to stabilize BP and HR (fluid loading, atropine, IV calcium,
glucagon, insulin/glucose, catecholamines; GP may need to be asked to
prescribe medications outside paramedic protocols) +/- RSI
If the team seek advice via phone or internet (poisons centre, ambulance
medical director, ED, toxinz.co.nz etc ) provide this note
BP slowly drops until at least 4 of 6 interventions above are completed, PEA
arrest (unrecoverable) if 4 interventions not performed in 20 min
Scenario end point
Patient stabilized for transfer (enough interventions performed) or cardiac arrest
after 20 min. If team elect to depart prior to 4 interventions end scenario and
inform them that patient did not survive the flight!
April 2013
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