All patients should be evaluated immediately for alterations of consciousness, hemodynamic instability, and respiratory impairment. Every patient requires an intravenous line, continuous ED cardiac monitoring, and an ECG. Serial ECGs will be required in most patients. Suggested laboratory studies include determinations of serum electrolyte, creatinine, and glucose levels. A quantitative serum acetaminophen level is recommended in all overdose patients. Most symptomatic patients will require arterial blood gas measurement. Patients with antimuscarinic symptoms may require a urinary catheter to prevent urinary retention and a nasogastric tube if bowel sounds are absent. Patients who are initially asymptomatic may deteriorate rapidly and therefore should be monitored closely for several hours. Emergency physicians should report all TCA exposures to a regional poison control center.
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