Atropine

atropine

I rank Atropine 12 out of the 33 drugs we carry.

Aside from routine use in cardiac arrest, I use Atropine two or three times a year for patients with symptomatic bradycardia. I have no reason to believe it does any good at all in cardiac arrest, but as far as symptomatic bradycardia, as long as the patient is not in a third-degree block, I have had good success with Atropine.

Earlier in my career, I used Atropine a bit more, but that was before I knew that many people thanks to beta blockers had every day pulses in the high 40′s, low 50′s. I also used to more readily give it to a patient having an MI (heart attack), which can increase their oxygen demand and cause more damage. Now I only give it to patients having an MI if they are hypoperfusing. Ah, the learning curve.

The best bradycardia calls are for the patient passed out in the bathroom. You find them on the floor, cold and clammy, no pressure, pulse in the 20′s. Straining to go to the bathroom, their vagus nerve overpowered them, knocking their heart rate down and they lacked the ability to rebound on their own. We used to give a full amp of Atropine, now we give 0.5, and if that doesn’t work another 0.5 mg, etc. A couple times I have given the full 1 mg by mistake. Old dogs. Still the drug works well, the pulse picks up, the patient wakes up, the skin colors up and drys out and all is well in paramedic land. “You fixed them,” the doctor says to me in the ED. Music to my ears.

If I don’t have atropine in my kit, I can always pace the patient. Other options are Dopamine and an epi drip.

***

We can also give Atropine to organophosphate poisionings, but I have never had one.

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Atropine (Atropine Sulfate)

Class: Antimuscarinic
Parasympathetic blocker
Anticholinergic

Action: Blocks acetylcholine (ACh) at muscarinic sites

Indication: Symptomatic bradyarrhythmias
Cholinergic poisonings
Asystole
Refractory bronchospasm

Contraindication: Relative contraindication wide complex bradycardia in the setting of acute ischemic chest pain

Side effects: Tachyarrhythmias
Exacerbation of Glaucoma
Precipitation of myocardial ischemia

Dose: Bradyarrhythmias – 0.5mg , may repeat every 3-5 minutes

Asystole – 1mg IV MR (May repeat) IV q 3-5 minutes (total max. dose 3mg)

Organophosphate poisonings – 1mg – 2mg; may repeat as needed

Route: IV push

Pedi dose: 0.02mg/kg IV

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Peter Canning

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  • Comments
    Mark J. Tenerowicz
    Patient Handover
    I am an ED doc and EMS medical director and I expect but don't demand that my crews leave their run form before clearing. Failure to do so should be the exception, not the rule. I realize services operate in the real world of limited resources and unpredictable calls. If it being done at the…
    2014-07-16 19:57:46
    David
    Patient Handover
    The techie in me dreams there may be a technological solution, with seamless integration of pre-hospital and inpatient charts, live updating, maybe even voice recognition that would be almost like dictation, getting everything in the correct fields in the software ... then I wake up, snort and chuckle a little. Seriously though, does anyone out…
    2014-06-27 23:54:42
    Dan
    Patient Handover
    Make it so I don't have 6 cords to choose from and the driver for the printer works from HH to JMH to Children's to RGH and maybe I won't fax every single runform in. But I have been saying that for years.
    2014-05-24 18:05:52
    KellyCormier
    Patient Handover
    Peter, This is a fight that I, just like yourself and so many others have looked at in my EMS history of 25 years.I'm in a pretty unique situation as a former provider, a wife of a firefighter and someone who works with medic and firefighters across the country. I have developed a different type…
    2014-05-15 21:39:31
    Vincent
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    Hi all, I have been in well above average fitness level all my life. Three years ago, while following an EMR class, I developed the taste for First Aid work. Since then I have work in the Oil/Gas industry, and volunteer to sport events and concerts now trying to finish my PCP-IV. I have to…
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