Beta-Blocker Overdose 

Assessment

Pediatric Pearls:	Signs & Symptoms:	Differential:
□ Fluids and medications titrated to maintain SBP > 70 + (age x 2) mmHg	□ Bradycardia □ Hypotension □ Altered mental status □ Weakness □ Shortness of breath □ Possible seizures	□ Sepsis □ Hypoxia □ Hypoglycemia

Clinical Management Options

EMT-B

• Place in position of comfort • Oxygen target SpO2 92% – 96%   • Check blood glucose level, especially in the pediatric patient

Paramedic

• IV / IO access as appropriate for patient condition  • Obtain EKG • Consider atropine sulfate for symptomatic bradycardia • Adult: Atropine 0.5 mg IV every 5 minutes to maximum of 3 mg • Pediatric: Atropine 0.02 mg/kg (0.1 – 0.5 mg per dose) every 5 minutes, maximum total dose 1 mg • Consider fluid challenge (20 mL/kg) for hypotension with associated bradycardia • For symptomatic patients consider Glucagon: • Glucagon 1 mg IVP (Over 25 kg) • Glucagon 0.5 mg IVP (less than 25 kg) • Consider vasopressors after adequate fluid resuscitation for the hypotensive patient  • Consider transcutaneous pacing if refractory to initial pharmacologic interventions • If widened QRS (100 msec or greater), consider sodium bicarbonate 1 meq/kg IV. This can be repeated as needed to narrow QRS