Initial Measures

Any patient with suspected CCB toxicity should have cardiac monitoring, supplemental oxygen, and at least one 18-gauge or larger intravenous catheter inserted with a normal saline infusion begun. A 10 to 20 cc/kg bolus should be administered to otherwise healthy patients with a systolic blood pressure below 90 mmHg or to patients with a history of hypertension who demonstrate a systolic blood pressure less than 100 mmHg. Venous blood should be drawn for electrolyte and creatinine determinations. In hypotensive patients with suspected drug overdose who remain very drowsy despite administration of naloxone, endotracheal intubation should be considered to ensure airway protection and facilitate further treatment measures. Cuff sphygmomanometry frequently produces inaccurate estimations of arterial blood pressure with shock. Accordingly, an intraarterial catheter should be inserted for persistent hypotension. Arterial blood gases and electrolytes should be examined to determine acid/base status and to guide the rate of oxygen delivery and minute ventilation based on Pa o2 and PaCO2 measurements. A widened anion gap indicates significant systemic hypoperfusion. Central venous catheterization should be performed for any patient who remains hypotensive after normal saline bolus or for any patient with documented congestive heart failure or anuric renal failure who manifests CCB toxicity. Patch-stick electrodes should be placed on the anterior and posterior chest to facilitate transcutaneous electrical pacing, should it be necessary.

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