An overview of the principles of antidote use in resuscitation, with a focus on three essential agents: naloxone, sodium bicarbonate, and high-dose insulin euglycaemic therapy.

1. Chris Nickson FACEM FCICM
Intensivist, Alfred Health
Innovation Lead, Centre for Health Innovation
Adjunct Clinical Associate Professor, Monash University
Image Credits: Trainspotting / Giphy

2. Financial
Conflicts of InterestNO
http://litfl.org/CONCEPTOS

3. Principles of antidote use
Key resus antidotes:
Naloxone
Sodium bicarbonate
High dose Insulin

4. Image source: https://www.tate.org.uk/art/artworks/fildes-the-doctor-n01522
PMID: 28669553

5. Image Credit: Adobe Stock

6. Image Credit: https://www.cbs58.com/news/opioid-overdose-antidote-naloxone-recalled-due-to-particulate-matter
PMID:
25865597
18641540
26289651

7. Naloxone 40mcg IV
q1-2 min until RR>10
and rousable
https://litfl.com/naloxone/

8. Toxic cardiac arrest
(or shock)
Early aggressive resuscitation:
• ABC & ACLS protocols
• Large bore intravenous access
• Crystalloid fluid bolus/catecholamines
• Early ECHO: pump vs vasoplegia
• Consult Poisons Centre/Toxicologist
BB/CCB NCBD (or WCT) Antidoted toxin* LA agent
HIE NaHCO3
Antidote ILE
Consider:
• Other Inotropes
• ECMO
• Haemodialysis
• IABP
• Cardiac pacing
• Vasopressin/4-AP
• ILE for lipophilic
All patients:
• Optimise electrolytes
• ILE for lipophilic
cardiac toxin
•
PMID: 21284810

9. QRS = 200 ms
R’ = 3mm
S = 4mm -> R’/S = 0.75

10. NaHCO3 1-2 mmol/kg
then
Hyperventilate to
pH 7.5-7.55
PMID: 26159649
https://litfl.com/sodium-bicarbonate/

11. Before

12. After

13. Photo by Incurable_hippie on Flickr

14. Insulin 1 unit/kg bolus
and
50% glucose 50mL
https://litfl.com/high-dose-insulin-euglycaemic-therapy/
PMID: 30141827

16. Then infusions
of
Insulin 0.5 unit/kg/h
and
50% glucose 50mL/h
https://litfl.com/high-dose-insulin-euglycaemic-therapy/
PMID: 30141827

17. http://litfl.com/laws-for-the-navigation-of-life/
Peter Safar’s
22nd Law for the
Navigation of Life
It is up to us to