EMS responded to a 72-year-old female who just took 90 tablets of 25mg metoprolol, a beta blocker.  She was ambulating and alert with normal vitals.  Consumption of this medication was a suicide attempt, and the patient reported, she was “tired of living”.  She had four prior suicide attempts.  She reports she had taken the medicine and called EMS.  EMS, recognizing the seriousness of this event monitored closely and started transport to Marymount ED.  Initial BP 129/79 heart rate was 59. While transporting she dropped to a heart rate of 46 and BP changed to 59/39 and she became less responsive.   As they prepared pacer patches, they administered 1mg Atropine.  Recognizing this as a cardiotoxic overdose, they initiated our recently updated protocol of calcium and beta blocker overdose.  They administered 1 Gm of Calcium Chloride with an excellent response, vitals started to stabilize so pacing was held off.  As the BP drifted downward, they appropriately used push dose epi, titrated to effect, and brought this patient to the ED in stable condition.  The patient went to the ICU and did very well.  This is a fantastic example of those moments in pre-hospital care that truly make a difference in a life-or-death situation.  Thinking calmly and acting quickly and appropriately absolutely saved this patient’s life.

         Beta blocker overdose is a complex event in which these patients may appear well initially and rapidly decline.  The old protocol used Glucagon in extremely high doses and some evidence in the past supported these efforts.  However, the Glucagon high dose therapy has not stood the test of time and has since been removed from the protocol.  These extremely ill and near-death patients can be overwhelming, and you may feel that you are throwing the kitchen sink at them to save their life.  I suggest following what these medics did.  Follow the algorithm and provide the necessary treatment in a timely manner as needed by the patient.  I am extremely proud of this crew and their care and compassion for this unfortunate situation, is in keeping with highest standards of our pre-hospital providers.  Well done!