MDI Overdose

[stever]

Had an interesting call the other day, curious what you guys would have done.

25 yo m presented with severe chest px following 25-35 hits off his MDI. PMHx of asthma, multiple suicide attempts, bi-polar (stated he took his other meds as prescribed). Initial vitals: 150's systolic, HR: 140's, sat-ing okay, all other exam unremarkable. Got him in the rig, o2, iv, monitor (sinus tach without ectopy or ST elevation). Go en route, pt c/o dizziness, light-headedness, vitals: HR 170's, BP: 100 systolic, still sinus w/o ectopy. Started a fluid bolus, then arrived at the ED.

My question (new medic here). Would you have done anything pharmacologically. And, I know albuterol / atrovent has some side effects, but how far could this have gone? PVC's? Coded?

Have you seen this before?

stever

[vs-eh?]

Sympathomimetic/anticholinergic OD with the possibility of beginning hypokalemia....

Which MDI did he take? Both?

[stever]

Sorry, it was a Combivent.

[AZCEP]

You could consider treating it like any other sympathomimetic toxidrome. Benzo's are your friends.

The anti-cholinergic situation would best be left to run it's course. Using a cholinergic agonist is really only intended for critically ill, and you really don't have any options.

[medic001918]

Given the sceanrio you posed, I wouldn't have gone to the drug bag to fix this problem. The medications he has taken have Beta one and two effects driving the heart rate up. A fluid challenge wouldn't be wrong, but doesn't really treat the underlying issue. Supportive care in this case is exactly how I would have handled the call.

Shane

NREMT-P

[ERDoc]

Bet he had the clearest lung sounds you've ever heard.

[akroeze]

Bet he had the clearest lung sounds you've ever heard.

This is a good point. If they ever asked you in court how sure you were that his lungs were clear = bilat I think you would be justified in smacking that lawyer upside the head