NREMT Emergency Medical Technician (EMT) Cognitive ExamMedical EmergenciesHard
A 25-year-old female is found unconscious in her bedroom by her roommate. There are several empty pill bottles, including one for amitriptyline, on the nightstand. Her respirations are slow and shallow, pulse is weak and rapid at 130 bpm, and pupils are dilated. What type of overdose is MOST likely?
- AOpioid overdose
- BStimulant overdose
- CTricyclic Antidepressant (TCA) overdose
- DBenzodiazepine overdose
Show answer & explanationAnswer & explanation
Correct answer: C. Tricyclic Antidepressant (TCA) overdose
Amitriptyline is a tricyclic antidepressant (TCA). TCA overdose typically presents with a 'wide complex' tachycardia, dilated pupils, altered mental status, and can include respiratory depression and seizures. The rapid pulse with dilated pupils and respiratory depression strongly suggests TCA toxicity.
Why the other options are wrong
- A. Opioid overdose typically causes pinpoint pupils, profound respiratory depression, and bradycardia, not dilated pupils and tachycardia.
- B. Stimulant overdose would cause tachycardia, hypertension, and agitation, but typically not respiratory depression or unconsciousness unless severe complications occur.
- D. Benzodiazepine overdose usually causes central nervous system depression (sedation, respiratory depression) but typically does not cause dilated pupils or significant tachycardia.
Tricyclic Antidepressant (TCA) Overdose
A life-threatening overdose characterized by anticholinergic effects (e.g., dilated pupils, tachycardia, dry skin), central nervous system depression, and significant cardiotoxicity, including wide QRS complex on ECG.
- Common TCA is amitriptyline.
- Key signs: altered mental status, dilated pupils, tachycardia, respiratory depression.
- Cardiotoxicity is a major concern, leading to dysrhythmias and wide QRS.
Memory trick: TOXIDROMES: Pupils, Pulse, Resps