ECG case 2

15 years old female patient has been found unresponsive with GCS 11/15 !
Diagnosis ? 
Treatment ?

Tricyclic Overdose, Tricyclic poisoning
Tricyclic poisoining block sodium channel. 
The two main adverse effects of sodium-channel blocker poisoning are:
1)Seizures 2)Ventricular dysrhythmias (due to blockade of sodium channels in the CNS and myocardium)
Features consistent with sodium-channel blockade are:
Interventricular conduction delay:
-QRS > 100 ms in lead II
-Right axis deviation of the terminal QRS: Terminal R wave > 3 mm in aVR
-R/S ratio > 0.7 in aVR
Patients with tricyclic overdose will also usually demonstrate sinus tachycardia secondary to muscarinic (M1) receptor blockade.

TCA toxicity with treatment: bicarbonate and hyperventilation