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.

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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
    Travis Jordan
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    Try CHAMPS (in a more logical order than SAMPLE) C - Chief Complaint H - History A - Allergies M - Medicines P - Previous Activity S - Signs/Symptoms (vitals)
    2015-02-26 03:01:09
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    Whether you are excellent at intubation or not is irrelevant. I can drop an iGel airway with an NG tube in a patient and apply the vent before most people could finish prepping for an intubation. That is the goal. Less time securing an airway and more time focusing on compressions, drug therapy, and reversing…
    2015-02-24 23:54:11
    Levi Peterkin
    The Butler Did It
    Good day, I have trouble making a patient report to a triage nurse. Sometimes I don't know how to remember all the important stuff and summarize it effectively.
    2015-02-23 18:27:14
    Dawn
    Dopamine
    What are your thoughts on titrating a dopamine drip drop off? Do you go from 5 to 0? Or do you ease from 5 to 0? I have a theoretical answer in my head, I just would like another's perspective.
    2015-02-23 16:04:24
    BH
    AHA 2015 Guidelines: A Preview
    If medics can't intubate with CPR in progress they need to train until they can, or more correctly, can't miss. At my level of care we don't even intubate a live person before being licensed and I regularly intubate with a Lucas device running. It ain't rocket science.
    2015-02-23 03:10:52

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