What is the first step in managing a TCA overdose?

In the management of a tricyclic antidepressant (TCA) overdose, the initial priority is to assess and stabilize the patient's airway, breathing, and circulation, commonly referred to as the ABCs. This step is critical because TCA overdoses can lead to significant cardiovascular and respiratory complications, including cardiotoxicity and central nervous system depression. By ensuring that the patient has a secure airway and adequate breathing and circulation, healthcare providers can prevent further deterioration of the patient’s condition.

Once the ABCs are stabilized, further interventions can be tailored based on the patient's symptoms and severity of the overdose. For instance, activated charcoal may be considered if the patient presents early after ingestion and is not at risk of airway compromise. Sodium bicarbonate can be a specific treatment in TCA overdose to address the associated metabolic acidosis and mitigate cardiotoxic effects; however, it is not the first step as ensuring stability comes before administration of specific antidotes or treatments. Starting intravenous fluids may be important later on for volume resuscitation but falls under further supportive care rather than the immediate management priority.