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EMS News-

FDA Votes to Eliminate Combination Drugs

Personal Doctor Refuse to Let EMT Declare Jackson Dead

Ambulance Safety Protocol Instituted by NAEMSP

Boy Arrested for Stealing From Ambulance


Tip of the Week Antidepressant Overdose

with Lisa Booze of the Maryland Poison Center

Antidepressants, particularly TCAs were one of the most important causes of mortality resulting from poisoning and continue to be responsible for more deaths per prescription than all the other antidepressants put together. They are identified as one of the most common causes of self poisoning and comes in second to analgesics as the most common drug taken in drug overdose resulting to fatality.

There following are the types of antidepressants:

  • Selective Serotonin Reuptake Inhibitors (SSRI)
    • eg. Prozac (fluoxetine), Paxil (paroxetine)
  • Serotonin and Norepinephrine Reuptake Inhibitors (SSNIs)
    • eg. )Effexor (venlafaxine), Cymbalta (duloxetine)
  • Tricyclic antidepressants (TCAs)
    • eg. Elavil (amitriptyline), Tofranil (imipramine)
  • Monoamine Oxidase Inhibitors (MAOIs)
    • eg. Nardil (phenelzine), Parnate (tranylcypromine)

Since antidepressants is one of the leading causes in drug poisoning seen in emergency departments, EMTs and paramedics should be on the lookout for clinical manifestations of antidepressant overdose.

The clinical features of antidepressant overdose include the following:


  • altered mental status, delirium, psychotic behavior, delirium and hallucinations and later proceeds to lethargy, stupor, and coma.
  • generalized seizures within 1-2 hours of ingestion
  • pyramidal signs
  • rigidity


  • Hypotension
  • Dysrhythmias
  • Conduction block
  • Slowed ventricular conduction
  • Sinus Tachycardia
  • Hypertension (early)
  • Cardiogenic shock


  • Acute lung injury
  • Hypoventilation
  • Aspiration pneumonitis
  • ARDS
  • Hypoxia

Anticholinergic effects

  • Hypothermia
  • Agitation (early)
  • Mydriasis
  • Dry skin and/or mucous membranes
  • Hyperthermia
  • Decreased gastric motility/ileus
  • Urinary retention

Emergency plan of management includes:

  • Assess and treat ABC’s as needed
  • Examination of clinical features
  • Use charcoal or gastric lavage if within 1 hour after ingestion
  • Give Sodium Bicarbonate for acidosis, arrhythmias and hypotension
  • IV fluids (inotropes) for hypotension
  • Monitor patient for risk of cardiac arrest and institute seizure precautions

Article on Antidepressant Toxicity

FDA: Understanding Antidepressant Medications

Emergency Medicine Journal: Review on Tricyclic Antidepressant Overdose


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“No More Summertime Blues” by Geoff Smith

Geoff Smith

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Until next time, Scene safety, BSI!

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