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I do it. First off, I don't buy the argument that it will increase myocardial oxygen demand through unopposed sympathetic stimulation. The heart rate is TOO LOW, so you're not going to have a runaway heart rate that will extend the infarct. We use dopamine and dobutamine all the time for this sort of thing without concern for extending the infarct. The best thing you can do for the infarcting heart is improve the supply. Second, a patient with a high degree AVB due to digoxin may benefit from atropine. AVB from dig is parasympathetically mediated through increased receptor sensitivity, increased PS transmission at the AV node, and direct PS stimulation. It is not going to cause harm in the emergency setting, takes no time to do, and is a lot less painful than pacing. 'zilla

They had 500 b/c they had ppl requesting them for collecting. They're big on providing for collectors, but I have no interest in keeping them, just screwing w/ ppl.