Could this kill someone?

[writer806]

Hey all. I have another quick question in regards to my creative writing piece that I'm working on for a college class. Say that somehow, atropine (1 mg I think,) was given instead of lidocaine (100 mg?) to a patient in v- tach. Let's say that the EMT grabbed the wrong syringe (if that's even possible, I'm not sure.) Could that kill the patient? This may be a stupid question, but I'm not too familiar with the medical field and want my story to be at least somewhat accurate. Thank you!

[fallout]

I believe atropine works specifically on the SA node while v-tach is the ventricles firing to attempt to maintain perfusion in the absence of signal from the higher pacemaker sites. 1 mg atropine would do nothing in that scenario in my opinion, but some more experienced people may provide the absolutely correct answer.

[thbarnes]

The patient is already in cardiac arrest, it's not a good situation to start with. But yes, atropine would make the situation worse.

Most services carry Atropine and Lidocaine in handy color-coded pre-filled syringes with the name of drug in big, bold letters on the side, I think to prevent this very thing from happening.

Lidocaine is an antiarrhythmic

Atropine is a parasympathetic blocker, essentially it accelerates the heart by blocking the brain's ability to slow it down and keep the heart rate in check

You're not slowing the heart-rate down with the lidocaine per-se, but you are trying to correct the dysrhythmia, which is tachycardic in nature, and return control of the heart back to the SA node, returning the rhythm to normal sinus. Either way, the atropine is not the exact opposite of what you were going for, but it's not good, because it accelerates the heart rate and does nothing for the dysrhythmia.

If the v-tach was caused by certain factors, such as muscle hypoxia or ischemia (in a heart attack for instance), then the atropine will increase the oxygen demand on the cardiac muscle, causing further damage.

The most likely outcome I forsee and others may have their own opinion, is the v-tach degenerating into PEA or asystole, which has much less probable chance of positive outcome.

[Thunderchild145]

I'd be mre inclined to agree with fallout. Atropine is a parasympatholytic, and the vagus nerve (Cranial Nerve 10[Parasympathetic]) really only innervates the atria. I think you'd see an increased atrial rate, no real change in the EKG and really no change in the patient's status. However if you did manage to convert the patient back to a sinus rhythm, you'd definatly see a sinus tachycardia, PAT or other re-entry supraventricular tachycardia. But also thbarnes is right in that when associated with AMI, atropine increases myocardial oxygen demand and could worsen the infarct.

In short, med errors happen. Can you kill someone? Damn right. Try not to. And in this case (an EMT grabbing the wrong syringe) that won't go on the EMT's license. It goes on the paramedic's license. Always double check your meds.

[vs-eh?]

One thing to remember is that both medications have effects that don't necessarily apply to a patient simply in cardiac arrest.

Lidocaine for example is given in LOAD pre-intubation for "heads" (increased ICP issues) and can be given to V-tach patients with a pulse. I have given lido (1mg/kg) to a person prior to intubation and didn't tube, they regained consciousness and they didn't die. In fact nothing happened really.

Atropine is often given in the LOAD preintubation for kids to prevent bradycardia, used for cholengeric toxidromes, etc...

Will it kill a person in V-Tach? Not directly, but it can contribute. Patients in V-tach with/without pulses basically have ventricular ectopy (for some reason) that has taken over as pacemaker. As TC145 said the atria actually still firing but are masked by the ventricular ectopy (noting P waves are good in differentiating say SVT with abarency from V-tach) Myocardial O2 demand increases and with atropine (parasympathertic fibers predominate in the atria) it will increase atrial rates and increase O2 demand. So you are making worse a bad situation. But it won't directly kill you as say, giving a NMB instead of fent. or something.

Remember...Atropine = Purple (1mg)....Lido = Pink (100mg)...

[zzyzx]

Besides its effect on the SA node, atropine increases the automaticity of myocardial cells. Considering that the myocardial cells probably already have increased automaticity due to being ischemic from the VT or from whatever event is causing the VT, giving atropine could send the heart into VF.

[fiznat]

It probably wouldnt kill the guy. There are, however, more creative ways that this VT patient could be killed!

-Using 10cc of 1:1000 solution Epinephrine (which is 10mg) IV push instead of the correct 10cc of 1:10,000 solution (1mg). Pretty sure that would kill your patient... and while it would take a pretty stupid medic to do it-- I dont doubt that someone somewhere has done it.

-Undetected esophageal intubation (supposedly happens all the time)

-Ineffective CPR (not really fancy, but this does kill people)

-Unrecgonised pericardial tamponade or pneumothorax

- etc

[Thunderchild145]

Hah. Thankfully I never seen a 1:1000 preload. I know 1:10000 comes in a 10cc preload for a 1mg dose but I've really only seen 1:1000 in amps and vials.

[BEorP]

-Ineffective CPR (not really fancy, but this does kill people)

It just doesn't bring them back, they were already dead

[Doczilla]

Atropine? Probably not, but the above concerns are valid.

Epi 1:1000 sometimes comes supplied in 30cc vials (30mg) in systems that use high-dose epi or mix their own epi drips. It is possible to make this mistake, and give 10cc (10mg) of epi instead of the intended 1mg. It might happen if the medic said to an unknowing or inexperienced partner "give me 10cc of epi". If his partner didn't look closely at the vial, and drew it up rather than using the prefilled 1mg/10cc syringe the medic was asking for, it might happen. This could very well be a lethal mistake.

Giving verapamil to someone in V-Tach, now that will kill someone. This may happen if the rhythm is misidentified. Verapamil treats "supraventricular" tachycardias, while lidocaine treats v-tach. Some supraventricular tachycardias have what is called a conduction aberrancy, which means the complexes appear wider than normal, sometimes mimicking v-tach. That's not a big deal if you give lidocaine (thinking they're in v-tach) to a patient in SVT, but if the medic thinks it's SVT with aberrancy and it's really v-tach, giving the verapamil is bad news. Some systems carry verapamil, though this is falling out of favor since we have cardizem.

'zilla