Toxic Ingestion Clinical Pathway — Emergency Department, ICU and Inpatient
Toxic Ingestion Clinical Pathway — Emergency Department, ICU and Inpatient
EKG
General Recommendations
- Not required for every pediatric poisoning.
- An EKG is recommended in the following cases:
- Any symptomatic poisoning
- Known or suspected exposure to drugs with myocardial effects
- Consider EKG in the following cases:
- Known or presumed polysubstance exposure
- Presumed exposure to an unknown substance
- Clinical concerns are present
EKG Interpretation and Cardiotoxic Substances
- There are numerous cardiotoxic substances and medications.
- A non-inclusive list of EKG changes with exemplar toxicants is provided below.
Note
- Recommend timely consultation with Poison Control Center if cardiotoxicity is suspected
- Review need for time-sensitive antidotes and medications
A non-inclusive list of EKG changes with associated substances is provided below.
Sinus Bradycardia |
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Sinus Tachycardia |
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Prolonged PR Can progress to complete heart block |
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Prolonged QTc Can progress to Torsades de Pointes |
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Prolonged QRS Can progress to wide complex ventricular tachycardia |
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ST Elevation or Depression |
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AV Block |
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PVCs Can progress to wide complex ventricular tachycardia |
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Tall, wide R wave, S in I and aVL |
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