Page 1 THE ECG IN TOXICOLOGY
Chris Nickson FACEM FCICM Intensivist, The Alfred ICU
Page 2 Financial Conflicts of Interest NO !
http://litfl.org/CONCEPTOS
Page 4 ECG
IN T
OXI
CO
LOG
Y
Screening!Identify ECG toxidromes!Risk stratify !Direct therapy!Monitor response
Page 5 1. Name the poison:!!
A. Quetiapine!B. Digoxin!C. Dothiepin!
Page 7 Answer: (C)!Dothiepin
Page 9 QRS = 200 ms!
R’ = 3mm!
S = 4mm -> R’/S = 0.75!
Page 10 Right axis deviation of terminal QRS !
Terminal R wave >3 mm R/S ratio >0.7!
Page 11 QRS widening !predicts TCA complications!
!>100 ms seizures !
>160 ms dysrhythmias
Page 14 2. Name the poison:!!
A. Quetiapine!B. Digoxin!C. Diltiazem!
Page 16 Answer: (B)!Digoxin
Page 18 Cardiac glycoside toxicity !!
increased automaticity!AV node blockade!
supraventricular tachycardia !
Page 19 Regularised atrial fibrillation!
Page 20 Atrial Flutter with high grade AV block!
Page 21 Bidirectional ventricular tachycardia!
Page 23 3. Name the poison:!!
A. Citalopram!B. Sotalol!C. Diltiazem!
Page 25 Answer: (B)!Sotalol
Page 27 QT interval = 600 ms!
HR = 40/min!
Page 28 Chan (2007) PMID:17881416 !
DANGER
SAFE
Page 29 The patient is at risk of…!
Page 32 We need a structured approach!
Page 33 Structured approach to the electrocardio(toxo)gram!
1 Rate and rhythm2 PR interval – heart block? !3 QRS duration in lead II !4 Right axis deviation of QRS !5 QT intervals6 Ectopy and increased automaticity 7 Complications
Page 34 http://litfl.org/CONCEPTOS