Thanks to Dr. Kedia for today’s daily pearl: you have a patient with suspected anticholinergic overdose and a prolonged QRS. You give bicarbonate and it normalizes. You want to give physostigmine, but don’t know the contraindications……

The contraindications for physostigmine are: Asthma, Gi/Gu obstruction, use of choline esters or depolarizing neuromuscular blockers. Additional concerns are: a vagotonic state, diabetes or cardiovascular disease but clinical judgement should always be used.

http://eresources.library.mssm.edu:2226/contents/physostigmine-drug-information?source=outline_link&view=text&anchor=F209681#F209681