Which specialist consultations are beneficial to patients with calcium channel blocker (CCB) toxicity?

Updated: Jan 04, 2021
  • Author: B Zane Horowitz, MD, FACMT; Chief Editor: Michael A Miller, MD  more...
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Answer

Many different specialists can help the physician to care for a patient who has ingested a CCB.

Consult an American Association of Poison Control Centers (AAPCC)–certified regional poison control center, with a specific request to speak directly to a medical toxicologist, in all cases to assist in management, because several treatment options exist and each case is unique. Even if the ED personnel do not need care advice for the patient with CCB overdose, notify the hospital's regional poison control center to document the overdose characteristics and help create an accurate database for epidemiologic studies. In general, working in partnership with regional poison control centers on all ingestions is a good practice.

All hemodynamically unstable patients require prolonged care in an adult or pediatric ICU; arrange for consultation with this service soon after starting treatment in the ED. If the hospital does not have an appropriate ICU, critical care transport to a more specialized hospital should be considered sooner rather than later when severe toxicity has already developed.

Cardiologists may be necessary to manage hemodynamically unstable patients. Request consultation with a cardiologist to place a transvenous pacemaker if capture cannot be accomplished with transthoracic cutaneous pacing pads. Patients may require cardiopulmonary bypass, extracorporeal membrane oxygenation (ECMO), or an intra-aortic balloon pump to maintain peripheral perfusion, and a cardiologist or cardiovascular surgery team may be needed in severe cases.

After any patient who has attempted suicide is medically stable, request a psychiatric consultation.


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