Abstract
The patient was a 42-year-old man who presented 1 hour after ingestion of 25 tablets of 75 mg amitriptyline and an unknown amount of alcohol. He had a history of alcoholism and depression. He was unconscious, flaccid, and unresponsive, with grunting shallow breathing and absent gag reflex. The temperature was 35°C, heart rate was 120 beats/min, and blood pressure was 140/90 mm Hg. On 14 L/min mask oxygen, his arterial pH was 7.29, the Pao2 was 57, and the Paco2 was 51 mm Hg. Urine toxicologic screen was ++ for amitriptyline, and the blood alcohol level was 181 mg/dL. The rhythm strips recorded at the time are shown in Fig 1.
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