THE ECG IN TOXICOLOGY Chris Nickson FACEM FCICM Intensivist, The Alfred ICU
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THE ECG IN TOXICOLOGY
Chris Nickson FACEM FCICM Intensivist, The Alfred ICU
Financial Conflicts of Interest NO !
http://litfl.org/CONCEPTOS
ECG
IN T
OXI
CO
LOG
Y
Screening!Identify ECG toxidromes!Risk stratify !Direct therapy!Monitor response
1. Name the poison:!!
A. Quetiapine!B. Digoxin!C. Dothiepin!
Answer: (C)!Dothiepin
QRS = 200 ms!
R’ = 3mm!
S = 4mm -> R’/S = 0.75!
Right axis deviation of terminal QRS !
Terminal R wave >3 mm R/S ratio >0.7!
QRS widening !predicts TCA complications!
!>100 ms seizures !
>160 ms dysrhythmias
Worse…!
Better!!
2. Name the poison:!!
A. Quetiapine!B. Digoxin!C. Diltiazem!
Answer: (B)!Digoxin
Cardiac glycoside toxicity !!
increased automaticity!AV node blockade!
supraventricular tachycardia !
Regularised atrial fibrillation!
Atrial Flutter with high grade AV block!
Bidirectional ventricular tachycardia!
Digoxin effect!
3. Name the poison:!!
A. Citalopram!B. Sotalol!C. Diltiazem!
Answer: (B)!Sotalol
QT interval = 600 ms!
HR = 40/min!
Chan (2007) PMID:17881416 !
DANGER
SAFE
The patient is at risk of…!
We need a structured approach!
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
http://litfl.org/CONCEPTOS
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