Atropine for bradycardia

Oral decontamination, atropine for bradycardia, phenytoin to improve AV conckjction, oral ion (change resin to treat hypedcalemia... 

A 79-year-old nursing home patient was given donepezil 50 mg in error. She developed nausea, vomiting, and persistent bradycardia—typical cholinergic adverse effects. She was treated with atropine, 0.2 mg as needed, for bradycardia (total dose 3 mg over 18 hours) and was discharged on the second day. 

Lunde P. Ventricular fibrillation after intravenous atropine for treatment of sinus bradycardia. Acta Med Scand 1976 199(5) 369-71. 

In a double-blind, randomized, controlled study of 77 children undergoing halothane anesthesia for adenoidect-omy, the effects of atropine 0.02 mg/kg, glycopyrrolate 0.04 mg/kg, and physiological saline were compared (9). There was no difference in the incidence of ventricular dysrhythmias. Atropine prevented bradycardia but was associated with sinus tachycardia in most patients. The bradycardias that occurred in the groups that received glycopyrrolate or placebo were short-lived and resolved spontaneously. 

Bradycardia is usually responsive to atropine. For hypotension, intravenous fluids should be administered and if unsuccessful, vasopressor therapy should be initiated. Most arrhythmias are refractory to drug management however, treatment should be guided by electrocardiographic changes. Sodium bicarbonate has theoretical disadvantages because of the sodium channel opening. There is no specific antidote. No specific laboratory tests are available. 

General supportive care is the focus of therapy. There is no antidote. Administration of activated charcoal may decrease absorption of the plant if given within an hour of the ingestion. Intravenous fluid and electrolyte replacement should be administrated as needed. Symptomatic patients should have continuous cardiac monitoring. Symptomatic bradycardia may be treated with atropine. For patients whose blood pressure does not respond to fluid replacement, vasopressors may be needed. Recovery can occur within hours to days. 

In addition to drugs in these classes, others may be used for certain arrhythmias. Digoxin may be used for treatment of atrial fibrillation, adrenaline for asystolic cardiac arrest, atropine for sinus bradycardia, methacholine (rarely) for supraventricular tachycardia, magnesium salts for ventricular arrhythmias, and calcium salts for ventricular arrhythmia due to hyperkalaemia. 

Glasgow scale E2M4V2) with profuse oral secretions, sweating, cyanosis, muscle fasciculations and convulsions, and was intubated. Organophosphate poisoning was not suspected at first, and he was treated with dopamine and isoprenaline to increase blood pressure and heart rate and with phenytoin to control the convulsions, but all of these treatments were without effect. At 3.5 h after exposure, he was treated with 2 mg IV of atropine, which immediately increased both heart rate and blood pressure, and 10 mg IV of diazepam, which controlled the convulsions. He was maintained on continuous IV atropine (3 mg day-1) and mechanical ventilation, and 9 days after exposure he became alert and was extubated. The authors stressed the importance of systemic atropine for treating the bradycardia produced by the VX. 

Severe cases of ciguatera may be accompanied by respiratory distress and cardiac disturbances. Supplemental oxygen and artificial respiration may be necessary. Atropine sulfate for bradycardia and dopamine infusion in cases of severe hypotension may be used (Yasumoto 1984). However, a drug that can prevent respiratory or cardiac failure in cases of ciguatera has not yet been found. Some authors feel that atropine sulfate may be contraindicated because it can make the respiratory mucus more viscous and difficult to aspirate (Johnson and Jong 1983 Halstead 1978). 

Acute treatment of patients with second- or third-degree AV nodal blockade consists primarily of administration of atropine, which maybe administered in the same doses as recommended for management of sinus bradycardia. In patients with hemodynamically unstable or severely symptomatic AV nodal blockade that is unresponsive to atropine and in whom temporary or transvenous pacing is not available or is ineffective, epinephrine (2 to 10 mcg/minute, titrate to response) and/or dopamine (2 to 10 mcg/kg/minute) maybe administered.14... 

In sinus bradycardia or incomplete heart block, lidocaine administration for the elimination of ventricular ectopy without prior acceleration in heart rate (eg, by atropine, isoproterenol or electric pacing) may promote more frequent and serious ventricular arrhythmias or complete heart block. Use with caution in patients with hypovolemia and shock, and all forms of heart block. 

Sradycard/a Atropine is used in the suppression of vagally mediated bradycardias. Preoperative medication Atropine, scopolamine, hyoscyamine, and glycopyrrolate are used as preanesthetic medication to control bronchial, nasal, pharyngeal, and salivary secretions and to block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation. Scopolamine is used for preanesthetic sedation and for obstetric amnesia. 

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