What is the most appropriate initial medication for a patient who has overdosed on cocaine with widened QRS?

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Multiple Choice

What is the most appropriate initial medication for a patient who has overdosed on cocaine with widened QRS?

In cocaine overdose with widened QRS, you’re dealing with two problems at once: excessive sympathetic stimulation and sodium-channel blockade in the heart. The best initial approach is to calm the patient and blunt the sympathetic surge while also reversing the sodium-channel–mediated conduction abnormality. Benzodiazepines quickly reduce agitation, tachycardia, hypertension, and seizure risk, lowering myocardial oxygen demand. Sodium bicarbonate helps reverse the sodium-channel blockade by increasing extracellular sodium and raising blood pH, which narrows the QRS and stabilizes cardiac conduction. Using both tackles both issues effectively and promptly. Naltrexone isn’t relevant here, and relying on only one treatment would miss one aspect of the problem.

In cocaine overdose with widened QRS, you’re dealing with two problems at once: excessive sympathetic stimulation and sodium-channel blockade in the heart. The best initial approach is to calm the patient and blunt the sympathetic surge while also reversing the sodium-channel–mediated conduction abnormality. Benzodiazepines quickly reduce agitation, tachycardia, hypertension, and seizure risk, lowering myocardial oxygen demand. Sodium bicarbonate helps reverse the sodium-channel blockade by increasing extracellular sodium and raising blood pH, which narrows the QRS and stabilizes cardiac conduction. Using both tackles both issues effectively and promptly. Naltrexone isn’t relevant here, and relying on only one treatment would miss one aspect of the problem.

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