Problems for Discussion - 2 - Antiarrhythmics

A 63-year-old female is having a Colle’s fracture reduced under a Bier’s block. Shortly after the administration of lignocaine into the affected arm she has a grand mal seizure.

1. Outline your initial management.
2. What factors may have contributed to the seizure?
3. How could lignocaine have resulted in this episode?
4. What is the likely time course of events and what factors may influence this?

A 53-year-old pharmacist is brought to hospital by ambulance with a police escort after being discovered having just ingested 1 gm of quinidine. He refuses to give a history and demands to see his lawyer. His HR is 90/min on a cardiac monitor. Further observations and examination is refused by the patient, who demands to leave. Whilst attempting to contact relatives to placate him he collapses on the bed motionless. The monitor shows a wide complex tachycardia.

1. Outline your immediate management?
2. What are your priorities if his cardiac status stabilises?
3. What measures are indicated for decontamination?
4. Thirty minutes later he begins fitting; what anticonvulsants are indicated?
5. When he recovers consciousness what further assessments are required?

A mother of a 3-year-old male rings the hospital concerned about her son who has ingested 1 of his grandmother’s Aratac tablets that she left out for her before going to the TAB. He appears well, she says but she is concerned.

1. What do you advise?
2. What management is required?