An alert 5-year-old swallowed three digoxin pills. Vitals show BP 90/40, P 48, R 30; ECG shows sinus brady with a first-degree block. What should you do?

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Multiple Choice

An alert 5-year-old swallowed three digoxin pills. Vitals show BP 90/40, P 48, R 30; ECG shows sinus brady with a first-degree block. What should you do?

Digoxin toxicity can slow the AV node and cause bradycardia with hypotension, so the immediate goal is to increase heart rate and reverse the toxic effect. The best first step in this setting is atropine to counteract the increased vagal tone and raise the heart rate. Use 0.02 mg/kg IV (a small pediatric dose, with typical minimum and maximum practical limits). If the bradycardia persists despite atropine, proceed to temporary pacing and obtain digoxin-specific antibody fragments to neutralize the toxin. Defibrillation is reserved for shockable rhythms like pulseless VT/VF, not for sinus bradycardia due to digoxin toxicity.

Digoxin toxicity can slow the AV node and cause bradycardia with hypotension, so the immediate goal is to increase heart rate and reverse the toxic effect. The best first step in this setting is atropine to counteract the increased vagal tone and raise the heart rate. Use 0.02 mg/kg IV (a small pediatric dose, with typical minimum and maximum practical limits). If the bradycardia persists despite atropine, proceed to temporary pacing and obtain digoxin-specific antibody fragments to neutralize the toxin. Defibrillation is reserved for shockable rhythms like pulseless VT/VF, not for sinus bradycardia due to digoxin toxicity.

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