Tricyclic Antidepressant Overdose – Board-Style Questions

What this deck covers

Tricyclic antidepressant overdose in 18 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. The width on the strip
2. One lead worth a look
3. Pushing the pH up
4. Why the complex widens
5. Dry, red and confused
6. Forty minutes and wide awake
7. Still flat after the fluid
8. Fitting on the trolley
9. Asking to go at midnight
10. Nothing like that in the house
11. When nothing is working
12. The wrong drug for the rhythm
13. Nothing in the bottle
14. Reversing the delirium
15. One or two is enough
16. A cup held at the bedside
17. Rotating around the line
18. Medically fit at last

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: The blood pressure, which is the only number worth following in this poisoning, A tall terminal R wave in lead aVR, with a rightward shift of the axis, Potassium chloride, given until the level sits at the upper end of normal, An immune reaction against the conducting tissue that follows the tablets, A dry flushed child with wide pupils, a fast pulse and a full bladder, Charcoal given routinely at any interval, since the drug is slowly absorbed, Dopamine, which works indirectly and is the preferred agent in this setting, Nothing, since a seizure in this poisoning always stops on its own quickly, Six hours of monitoring with a normal tracing before she can be let go, A cough medicine bought at the chemist, which contains a similar compound, A beta blocker infusion to slow the rate and allow the heart to fill better, It is wrong because it is given far too slowly to be useful in this setting, Pass a catheter for retention, and remove it once the effect wears off, The drug is effective but works too slowly to be of any use in a child.

Clinical pearls from this deck

• The QRS width is the number that predicts trouble.
• Look at aVR: a tall terminal R wave is the clue.
• Sodium and alkali together open the blocked channel.
• A blocked sodium channel widens the complex.
• Dry, red, fast and retaining: the muscarinic block.
• Charcoal early, and only with a protected airway.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all emergency and critical care case decks · pediatric reference values.