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Seems like most are in agreement here. I agree, Atropine first, while getting ready to pace. However- Based on the vitals, by definition this person IS unstable (hypotensive, altered LOC), which means in my system, TCP is the treatment of choice. That said, in similar situations I have pushed atropine first, and it sometimes works- at least in the short term, but I ALWAYS would apply the pacing pads next, just in case. It also depends on the patient- some folks can tolerate that BP very well, and altered LOC could mean they are a bit weak or sleepy. You could have a patient who can tolerate those vitals for a surprising amount of time, or they could be rapidly decompensating right before your eyes. Clearly you would be more aggressive(pacing first) in those situations. I've had patients who call for general weakness, and upon exam, we find they are walking around with a complete heart block, possibly for a day or more. Would I immediately strap them down and start pacing? No- one step at a time. Evaluate and treat the patient, not just their stated problem. Obviously it can also depend on how many hands you have, but unlike trauma, medical/cardiac calls are situations where we really can make a difference.- We can at least stabilize the patient and buy some time for the hospital to get their ducks in a row- notify cardiology, get an internal pacer ready, notify the interventional cardiology suite and/or OR, notify family, etc. As was noted, medicine is an art, and yes, protocols are guidelines, but sometimes there's more to what we do than simply cookbook medicine. Experience gives us judgment and perspective, and we need to use that. To me, that is a defining characteristic of a good provider- balancing book smarts with common sense.

What does that even mean? I could walk before you were even a sperm in your drunk daddy's balls. Are you being intentionally dense? First of all you keep talking about Atropine like it is used for any heartblock. I don't know what they teach you in the Caribbeans, but here in the states we prefer evidence-based medicine. Atropine in 3rd degree blocks is well documented to cause a cardiac arrest.

As well as working as an emt i also volunteer at the local childrens hospital. On this particular day i was in the room of an 11 year old boy with cancer. He knew he was about to get a shot and thus was giving the nurses, volunteers and his mother a very hard time by kicking and screaming. We tried very hard to calm him down to get the medication into him but he was moving to much.. then all of a sudden he stopped moving, stopped crying stopped screaming ect. everyone in the room went into first gear getting oxygen and checking vitals. After a thorough check we found nothing wrong with him and figured he was faking. I figured the nurses would use smelling salts and he would "wake up" but no, the nurse motioned for us to folllow her out of the room. She told us, go along with this and he will wake up. we walk back in the room and the nurse fooled around with the ekg moniter. The screen showed flat line. She then takes the bed sheet and covers the boy up and looks at the mon with a face that looked very serious and she says "ma'm i am so sorry but I think we have lost your son. The boy all of a sudden jumps up and screams, no mommy no I am alive mommy. After a stern talking to he promised he would never do it again and we were able to give the medication. I think he learned his lesson.