Last P2 lab there was a good discussion about a patient who overdosed on caffeine. The patient's HR was 190, in SVT. How should this be managed? - Supportive care first → oxygen, IV access, cardiac monitoring. - Benzodiazepines (e.g., midazolam, diazepam, lorazepam) → first-line to reduce sympathetic surge, agitation, and rate. - Avoid adenosine or beta-blockers initially in massive caffeine overdose, because underlying mechanism is not a pure AV node reentry — and abrupt AV nodal block may worsen instability. - Calcium channel blockers (diltiazem, verapamil) slow AV node conduction, but they don’t address the underlying catecholamine storm and can drop blood pressure in an already unstable overdose patient. - Fluids → for perfusion support. - Transport to ED → may need activated charcoal (if recent ingestion), antiarrhythmics (like esmolol), or even dialysis in severe cases.