While preparing for the ambulance to arrive, Dr. Frank told the nurse to set up a room for lavage, and walked down the hall to find Dr. Edwards, the professor of clinical medicine. This was Dr. Frank's first serious nicotine poisoning, and she didn't want to leave anything to chance. The old-time docs used tobacco enemas to cure intestinal parasites. It causes CNS stimulation followed by bradycardia, hypotension, atrial and ventricular arrhythmias, seizures and coma. Atrial arrhythmias are most common, and I remember reading about at least one death from V tach.
Treatment is aimed at maintaining the respirations and blood pressure.
Atropine can be used for asystole, bradycardia and the cholinergic symptoms. Diazepam or lorazepam can be used for seizures. But you have seen one other nicotine overdose. By the time his wife drove him in, he was in atrial fib. He was anxious, sweating, hypertensive and complained of chest discomfort.