Atropine

Question 1

Atropine classification

Answer 1

PARASYMPATHETIC BLOCKER, ANTI-CHOLINERGIC

Question 2

Atropine action

Answer 2

1. Cardiac
   a. Blocks vagus nerve, results in positive chronotropic effect
   b. Positive dromotropic effect
2. Noncardiac
   a. Decrease body secretions
   b. Dilated pupils and paralysis of ciliary muscle
   c. Decrease bladder tone increase urinary retention
   d. CNS stimulation

Question 3

Atropine onset and duration

Answer 3

1. IV-immediate

2. 4 hours

Question 4

Atropine indications

Answer 4

1. SYMPTOMATIC BRADYCARDIA
2. 2nd or 3rd degree heart block, asystole
3. Organophosphate anti-cholinesterase poisoning
4. Nerve agent poisoning
5. Premedication for pediatric RSI

Question 5

Atropine contraindication

Answer 5

1. A-fib, A-flutter
2. HR > 60
3. BRADYCARDIA SECONDARY to ICP (STROKE, TRAUMA)
4. Hypothermic bradycardia

Question 6

Atropine use with caution

Answer 6

1. Do not mix with sodium bicarb

2. Be certain bradycardia is not due to hypoxia or head injuries

Question 7

Atropine dosage and administration

Answer 7

1. Bradycardia
   a. .5MG IV, EVERY 3-5 MIN AS NEEDED; NOT TO EXCEED TOTAL OF 3MG FOR ADULT
   b. Use 3 minute dosing interval and higher doses in severe conditions
   c. ET:1mg diluted in 10ml NS
   d. Pediatric: .02mg/kg - Min single dose = .1mg, Max single dose = .5mg, Max total dose = 1mg, Max adolescent single dose = 1mg, Max adolescent total dose = 2mg, May double for 2nd IV dose, ET = .05mg/kg diluted in 5ml NS
2. Anti-cholinesterase/ organophosphate/ nerve agent poisoning
   a. Adult: 1mg IV every 1 min until symptoms clear up, max dose 10mg
   b. If using the DuoDote Mark I antidote kits, give one atropine injector (2 mg) into the thigh, follow with two PAM chloride injections. Make give up to 3 sets
   c. Pediatric: < 12 yo start with .5mg IV/IO and repeat every 1 min until symptoms clear, max dose 10mg.
   d. Pediatric-RSI: .02mg/kg (min dose 0.1mg, max dose .5mg)

Question 8

Atropine adverse reactions

Answer 8

1. Cardiac
   a. Tachycardia
   b. Palpitations
   c. V-fib
   d. Paradoxical bradycardia when pushed too slow
2. Noncardiac
   a. Dry mouth, diplopia, restlessness, your debility, change in mental state, pain at the injection site

Question 9

Atropine reference in protocol

Answer 9

Cardiac
Environmental (organophosphate poisoning)
RSI
Pediatric cardiac arrest guide