Case Introduction

You are working a shift at EM Clerkshift General when you are called to the resuscitation bay to see an elderly patient with unstable vitals brought in by EMS.

Initial Vitals

  • Temp 98.0F
  • HR 43
  • RR 18
  • BP 60/40
  • O2 98%

Critical Actions

  • Diagnose the etiology for the bradycardia (BB overdose)
  • Administer Atropine
  • Administer Glucagon
  • Administer Epinephrine drip
  • Attempt transcutaneous/transvenous pacing
  • Administer high-dose Insulin therapy

Final Diagnosis

Beta Blocker Overdose

Tips and Tricks

  • Keep in mind the broad differential for severe bradycardia – ischemia, ingestion, electrolyte abnormalities, intrinsic arrhythmia/heart block, hypothyroidism, hypothermia, hypoglycemia, hypoxia, increased intracranial pressure, neurogenic shock.

Further Reading

High Dose Insulin Therapy (EMCRIT)

Low and Slow Poisoning (EMCASES)