• Emerg. Med. Clin. North Am. · May 2022

    Review

    Cardiotoxic Medication Poisoning.

    • Jon B Cole and Ann M Arens.
    • Department of Emergency Medicine, Hennepin Healthcare, 701 Park Ave, Mail Code: RL.240, Minneapolis, MN 55415, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA. Electronic address: Jon.cole@hcmed.org.
    • Emerg. Med. Clin. North Am. 2022 May 1; 40 (2): 395-416.

    AbstractBeta-blockers and calcium channel blockers result in a disproportionate number of fatalities from cardiac medication overdoses, and share similar characteristics. High-dose insulin is a superior therapy for both overdoses, but is likely synergistic with vasopressors; therefore we recommend starting vasopressors and high-dose insulin simultaneously. Digoxin remains an important cardiac poison and can likely be safely treated with smaller doses of fab fragments than in the past, except for patients in extremis. Extracorporeal membrane oxygenation is an invasive but promising nonspecific therapy for refractory shock from cardiotoxic overdose and should be considered primarily in cases of refractory cardiogenic shock.Copyright © 2022 Elsevier Inc. All rights reserved.

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