Key messages

• Death in b-blocker poisoning is usually due to pump failure rather than cardiac dysrhythmias.

• The degree of hypotension reflects the severity of toxicity; bradycardia is not useful in assessing toxicity as it occurs at therapeutic levels.

• Pulmonary artery wedge pressure and cardiac output should be measured in the seriously ill patient and in patients with pre-existing cardiac disease.

• In hypotension the treatment of choice is glucagon and a massive dose may be needed.

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