ICU Map
toxicology

Wide-QRS Toxicologic Shock

Seizures, QRS widening, ventricular dysrhythmia or shock after sodium-channel blocker exposure.

Recognize

  • QRS widening, terminal R in aVR, ventricular dysrhythmia, hypotension and seizures after a compatible exposure indicate severe cardiotoxicity; clinical toxicity matters more than a serum TCA concentration.

Act

  • Give IV sodium bicarbonate for QRS widening, ventricular dysrhythmia or hypotension due to TCA/sodium-channel blockade; repeat boluses and/or infusion are titrated to ECG/hemodynamic response while avoiding extreme alkalemia/hypernatremia.

Reassess

  • Reassess trajectory, organ support, competing diagnoses and failure of first-line therapy; escalate early when physiology is worsening.

Evidence status

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Actionable Clinical Workflows (1)

Step-by-step ICU Processes
Tricyclic & Sodium-Channel Blocker Toxicity — ICU Decision Pathway

Recognition and resuscitation of sodium-channel blocker poisoning with seizures, QRS widening, ventricular dysrhythmia and shock.

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Deep-Dive Topic Destinations (1)

Reference Knowledge
Tricyclic & Sodium-Channel Blocker Toxicitytoxicology

Recognition and resuscitation of sodium-channel blocker poisoning with seizures, QRS widening, ventricular dysrhythmia and shock.

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