Calcium Channel Blocker Overdose 

Assessment

Pediatric Pearls:	Signs & Symptoms:	Differential:
□ Fluids and medications titrated to maintain SBP > 70 + (age x 2) mmHg	□ Bradycardia □ Hypotension □ Decreased AV Nodal conduction □ Cardiogenic shock □ Hyperglycemia seizures	□ Sepsis □ Hypoxia □ Hypoglycemia

Clinical Management Options

EMT-B

• Place in position of comfort • Oxygen target SpO2 92% – 96%   • Obtain blood glucose level

Paramedic

• IV / IO access as appropriate for patient condition  • Obtain an 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 to 0.5 mg per dose) every 5 minutes, maximum total dose 1 mg • Consider calcium chloride • Adult: Calcium chloride 1 g slow IVP • Pediatric: Calcium chloride 20 mg/kg (0.2 mL/kg) slow IVP/IO. Maximum dose 1 g or 10 mL • Consider IV fluid 20 mL/kg up to 1 liter, repeat as indicated • Consider vasopressors after adequate fluid resuscitation for the hypotensive patient • Consider Glucagon if atropine, calcium, and vasopressors have failed: • Glucagon 1 mg IVP (Over 25 kg) • Glucagon 0.5 mg IVP (less than 25 kg) • Consider transcutaneous pacing if refractory to initial pharmacologic interventions