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.

***

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

4 Comments

Leave a Reply

Your email address will not be published. Required fields are marked *

background image Blogger Img

Peter Canning

JEMS Talk: Google Hangout

Recent Posts
Thoughts on Ebola October 23, 2014
STEMI Call October 14, 2014
Ebola October 2, 2014
Breaker of Men September 25, 2014
Categories
  • ems-health-safety (7)
  • ems-topics (698)
  • hazmat (1)
  • Uncategorized (413)
  • Comments
    tom combs
    Thoughts on Ebola
    Best effort is to quarantine/contain in W. Africa. Flight restrict all wanting to leave until 21 day safe or otherwise proven to be zero risk. It's in everyone's best interest. Here is a radio interview I gave 10/13. Unfortunately the situation is essentially unchanged. Thanks and be safe! I appreciate what you do. http://www.rmapublicity.com/images/stories/Audio/Nerve%20Damage%20-%20Wall%20Street%20Journal%20Tji%20Morning%20-%20October%2013,%202014.mp3
    2014-10-24 14:26:16
    Vince D
    Connecticut Limits Long Boards
    Beautiful! Congrats!!! I think this is the perfect level of aggressiveness and I can't imagine any regions advocating less intervention for a really long time. In fact, I don't think I'd want anyone being more aggressive than this with SSI for a long time. The only line that had me stroking my chin was: "Elevated…
    2014-10-23 08:43:16
    ParamedicTC
    Ebola
    Check out this site with an informative graph.
    2014-10-22 23:39:21
    Don
    STEMI Call
    Thank you for a good honest post. I think those classic or "typical" presentations we learn in school are the exceptions really.
    2014-10-18 17:34:21
    Ezio
    STEMI Call
    Someone has rearranged the position of the leads for a quicker reading, personally I would use that format because I read the leads in groups (II III AvF, I AvL, AvR)
    2014-10-16 05:22:59

    Now Available: Mortal Men

    Mortal Men is available as an electronic book for Kindle, Nook or any other e-reader. Here is a link to some of the places to buy it. The book sells for $3.99. Barnes and Noble Amazon Smashwords Scribd Also Available from iBooks

    Order My Books

    Support EMS Bloggers, Buy Their Books

    Google

    Order Books and Movies

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS