atropine for brady

[DirtJerZ]

Has anyone heard of or have in their protocols: give 1mg of atropine to a symptomatic bradycardic patient after an administration of .5mg with no change?

If they are symptomatic, we start a line, try 0.5mg of atropine and go to pacing, after we have capture and the patients BP is normalized we can try some versed for sedation. If your definition of symptomatic is the same as mine it means unstable and our protocols are pretty cut and dry.

[jwraider]

Our protocols have TCP first but say "consider atropine while waiting for TCP". I'm still a student so forgive me but wouldn't setting up pacing be faster than starting an IV and drawing up the med etc?

Here in Alameda county, CA it's 0.5mg repeatable to max 3mg (no different 2nd dose but I have seen that in a different county).

[p3medic]

Applying pacer pads is quicker than starting an IV in most cases, however most people find TCP to be fairly uncomfortable, so sedation should be given when possible. The patient with depressed LOC and a heart rate of 20 probably needs immediate pacing, however the dizzy, diaphoretic bradycardia might well wait for the IV sedation, and if your going to place an IV before initiating TCP, a trial of atropine might be warranted.

[AZCEP]

Keep in mind the adult human tends to do pretty good with slow heart rates. 30-40 can typically be tolerated for quite a while.

It is not uncommon to find a patient with a vague complaint that you would not suspect to be cardiac in nature and go through all of the other possibilities only to place them on the monitor and find something dramatic.

In those cases, vascular access has already been achieved, and a trial of atropine can be used. You might also consider that if your protocols were taken directly from the ECC guidelines, chances are the wording wasn't altered to make more sense for the prehospital environment.

[DirtJerZ]

Our protocols have TCP first but say "consider atropine while waiting for TCP". I'm still a student so forgive me but wouldn't setting up pacing be faster than starting an IV and drawing up the med etc?

Here in Alameda county, CA it's 0.5mg repeatable to max 3mg (no different 2nd dose but I have seen that in a different county).

yes according to ACLS protocols you can repeat atropine to a max of 3mg. they also state that if pacing is ineffective and the patient has poor perfusion you consider an epinephrine or dopamine infusion at 2-10 mcg/min. Atropine will most likely not work on a high degree block i.e 3rd degree or 2nd degree type II. Its more imperative that you get the pads on the patient.

[explenture]

Our protocol says 1 mg every 3-5 minutes up .04 mg.kg. In my experience there is a lot more asymptomatic than symptomatic brady.

[DirtJerZ]

Our protocol says 1 mg every 3-5 minutes up .04 mg.kg. In my experience there is a lot more asymptomatic than symptomatic brady.

Not to nitpick but the 0.04mg/kg for atropine was changed to 3mg with the new ACLS protocols.

[JPINFV]

Quick question about Atropine, what's the point for the 3 mg limit vs a size limit? Is it just that if it's not working by 3 mg, it's probably not going to work at all?

[ccmedoc]

Quick question about Atropine, what's the point for the 3 mg limit vs a size limit? Is it just that if it's not working by 3 mg, it's probably not going to work at all?

Yeah, according to the FDA, "three milligrams (0.04 mg/kg) given I.V. is a fully vagolytic dose in most patients."

I don't know about you, but most people that I give it to weigh more than 165 lbs.

The best I can figure is that the .04 mg/kg is for the smaller individuals, just stop at 3mg for the big ones or patients that are simply bradycardic. We have been giving it in arrests as a single bolus of 3mg at times, depending on the doc.

[Laura Anne]

Yup, our protocols read that a patient presenting with mild symptoms resulting from bradycardia can be treated with 0.5-1.0mg IVP of Atropine. Mind you, we've all heard that starting out with the lower dose is preferred when it comes to administering.... well ANYTHING basically in our field, BUT... :roll:

Pros: well gee, it can save your life. Seriously, by increasing the HR it can help a patient who seems to be SOB due to the functions of the body not receiving enough O2 because of the low HR....

Cons: gotta watch out for those low doses becauses they can have a paradoxical effect, plus perhaps the heart block is due to ischemia.... increasing the heart rate will circulate the O2 enriched blood. REPEAT!! O2 enriched BLOOD. If you don't have someone on high flow O2 prior to this, you can ultimately cause MORE damage in the long run by increasing the ischemia to the muscle which was causing the block in the first place. So, make sure they don't have a block.

Naturally, correct me please if I am wrong!! Just my ever so often two cents worth.... 8)