Andreas Engelbrecht
University of Pretoria, South Africa
Title: An audit of the management of tricyclic antidepressant overdose in the Emergency Unit of Steve Biko Academic Hospital, Pretoria, South-Africa from 2009 to 2012.
Biography
Biography: Andreas Engelbrecht
Abstract
Background: Tricyclic antidepressants (TCA) are frequently used in South-Africa due to their availability and low costs. These drugs are highly toxic in overdose. Aim: The aim of the study was to audit the key aspects in the management of patients with TCA overdose against an international benchmark.rnMethods: A cross sectional descriptive audit of clinical records was done. The findings were measured against the Guidelines for medical therapy of the emergency network (GEM net). rnResults: Thirty-two clinical records were recruited and audited. The following findings were made: The vital signs of 30 (93.7%) patients were recorded, 21 (70%) were abnormal. One case with hypotension was not managed appropriately. Eighteen (56%) patients had their blood pH analysed and 6 were abnormal. None of these were managed appropriately. Thirty (93.7%) EKG assessments were done. Only 17 (56.6%) were recorded. Five (29%) printouts could be found within the files. Of these 4 (80%) had an abnormal tracing but had not been treated. Of those EKGs only documented, 3 (25%) were described as abnormal but were managed inappropriately. Treatment with bicarbonate was either omitted or done inappropriately and without monitoring. The level of consciousness of 31 (96%) patients was recorded. Three who required intubation were not intubated.rnrnConclusion: The management of TCA overdose did not meet the standards prescribed by GEM net in our sample. This audit had a number of limitations but was used to improve the management of this condition in our unit and may be useful to others.
