This opioid antagonist is a useful adjunct in the management of opioid intoxication, particularly if there is CNS or respiratory depression. Caution is advised in those who are opiate-dependant and naloxone should only be used if there is significant CNS (GCS <12) and respiratory depression (RR <8).
Methylene Blue is the treatment of choice for symptomatic drug-induced methaemoglobinaemia (signs of hypoxia with chest pain, dyspnoea or confusion) or consider in asymptomatic patients with methaemoglobin (MetHb) levels >20%.
Intravenous lipid emulsion (IVLE) is a sterile emulsion of soyabean oil in water, used in parenteral nutrition. It is a novel antidote which requires further study but may have a role to play in the resuscitation of patients with refractory cardiac arrest induced by local anaesthetics that are resistant to standard protocols.
Idarucizumab is the antidote to dabigatran. Perhaps the hardest thing about it is saying its name. Eye-da-roo-ciz-oo-mab or praxbind until to comes off label. It is a humanised monoclonal antibody fragment (Fab) that binds to dabigatran with very high affinity (340x fold more than dabigatran binds to thrombin).
Hydroxocobalamin is a vitamin B12 (cyanocobalamin) precursor. In high doses, it is an effective chelator of cyanide. It is also the preferred antidote to cyanide poisoning due to its low side effect profile, thus if given to a patient without cyanide poisoning there is low risk of an adverse outcome
Symptomatic hypoglycaemia resulting from toxic exposures must be immediately corrected by administration of glucose. In all but the mildest of cases this is achieved with an intravenous bolus of hypertonic glucose solution
Polypeptide hormone secreted by the alpha-cells of the pancreas. Supra-physiological doses have previously been advocated in the management of beta-blocker and calcium channel blocker poisoning but this practice is now largely abandoned.
Flumazenil is a competitive benzodiazepine antagonist with a limited role in the management of benzodiazepine poisoning. Usually to reverse procedural sedation, accidental paediatric ingestion with compromise, and rarely to help make a diagnosis of benzodiazepine overdose or if a patient's airway is compromised without quick access to intubation equipment
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