Ca⁺⁺ Channel Blockers

Management

• Maintain airway (±RSI with low dose Ketamine)
• Fluid bolus (particularly if RSI planned) but beware pulm. oedema
• Insulin - bolus 1 Unit/kg then infusion 0.5 Units/kg/hr
• Monitor (@ 30min) bld glucose (dextrose 10% only if hypoglycaemia). Monitor for ↓K⁺
• Dirty adrenaline (counter vasodilation, Neg. chronotropic & Neg. inotropic effects of Ca⁺⁺ blockers)
• Give Ca⁺⁺(1-2G CaCl or 3-6G Ca Gluconate as a bolus every 5-10min ±infusion 4G CaCl Hr^-1)
• ± central line inotropes
• No evidence to support Glucagon (beware vomiting) 1-5mg IV
• External pacing may be worth a try after the above
• Consider NG charcoal if intubated and slow-release agents ingested
• Consider BRASH

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