Question

A patient on anti-depressants presented to you with hypotension. An ECG was done, which showed wide QRS complexes and right axis deviation. How will you manage this patient?

• A. Antiarrhythmics
• B. Intravenous sodium bicarbonate
• C. Propranolol
• D. Phenytoin

Answer 1

The Correct Option is C

In the given scenario, the patient on anti-depressants presents with hypotension, wide QRS complexes, and right axis deviation on ECG. These findings are indicative of a tricyclic antidepressant (TCA) overdose, which often causes cardiac abnormalities due to sodium channel blockade.

The appropriate management for a patient with suspected TCA overdose exhibiting cardiotoxic effects (such as wide QRS complexes) involves the use of intravenous sodium bicarbonate. This treatment works by increasing plasma pH and sodium levels, which helps to counteract the blockade effect on the sodium channels.

Therefore, the correct management option is:

• Intravenous sodium bicarbonate

The incorrectly marked correct answer "Propranolol" is not suitable in this case. Propranolol, a non-selective beta-blocker, is not indicated for the management of wide QRS complex and right axis deviation resulting from TCA overdose. It could worsen hypotension and cardiac conduction disturbances.