Cardiac arrest atropine

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. 

Atropine may be given to prevent cardiac arrest resulting from vagal reflex activation, incident to anesthetic in-ductioa gastric lavage, or endoscopic procedures. 

Sinus bradycardia. An abnormally low sinoatrial impulse rate (<60/min) can be raised by parasympatholytics. The quaternary ipratropium is preferable to atropine, because it lacks CNS penetrability (p. 107). Sympathomimet-ics also exert a positive chronotropic action they have the disadvantage of increasing myocardial excitability (and automaticity) and, thus, promoting ectopic impulse generation (tendency to extrasystolic beats). In cardiac arrest epinephrine can be used to reinitiate heart beat... 

Q3 Patients who suffer a cardiac arrest are usually given epinephrine (adrenaline) and external cardiac massage. If necessary, atropine is also administered. Explain the pharmacological actions of epinephrine and atropine on the heart. 

Only six of 36 children who took overdoses of co-phenotrope had signs of atropine overdose (central nervous system excitement, hypertension, fever, flushed dry skin) (1). Opioid overdose (central nervous system and respiratory depression with miosis) predominated or occurred without any signs of atropine toxicity in 33 cases (92%). Diphenoxylate-induced hjrpoxia was the major problem and was associated with slow or fast respiration, hypotonia or rigidity, cardiac arrest, and in three cases cerebral edema and death. Respiratory depression recurred 13-24 hours after the ingestion in seven cases and was probably due to accumulation of difenoxine, an active metabolite of diphenoxylate. Recommended treatment is an intravenous bolus dose of naloxone, followed by a continuous intravenous infusion, prompt gastric lavage, repeated administration of activated charcoal, and close monitoring for 24 hours. 

Four prisoners drank a decoction of yew needles (T. baccata) (12). Two died in prison with cardiac arrest. One went into deep coma, and had several episodes of ventricular fibrillation, controlled by defibrillation after return of consciousness his general condition deteriorated suddenly, he lost consciousness again, his circulation stopped, and he died on the fourth day. The other patient drank a much smaller amount of the decoction he was conscious, had bradycardia requiring transient pacemaking, and had a mild ventricular dysrhythmia he recovered after 10 days. In both cases there was excessive diuresis and severe hypokalemia and atropine was effective for a short time in the control of bradycardia. 

Atropine may be used to treat some types of arrltythmias. It increases the heart rate hy blocking the effects of ACh on the vagus. In this context, it is used to treat certain reversible hiadyairhythmias that may aceompany aeute myocardial in-raiction. It is also used us an adjunct to anesthesia to protect against bradycardia, hypotension, and even cardiac arrest ittduccd by the skeletal muscle relaxant sueeinylcholine chloride. 

Do not give IM or IV. Violent cholinergic reaction (circulatory collapse severe hypotension, bloody diarrhea, shock, cardiac arrest) will occur. Antidote 0-0.6-1.2 mg atropine sulfate Give 1 hour before or 2 hour after meals. If patient complains of gastric pain, the drug may be given with meals. 

Similar effects were observed (60) with rabbit hearts. Corycavine slowed the pulse to approximately half the initial rate which was not altered by atropine. Death occurred in cardiac arrest. 

A 64-year-old woman was treated for hypertrophic cardiomyopathy with amiodarone 1.2 g daily and atenolol 50 mg daily. Five days later the atenolol was replaced by metoprolol 100 mg daily. Within 3 hours she complained of dizziness, weakness and blurred vision. On examination she was found to be pale and sweating with a pulse rate of 20 bpm. Her systolic blood pressure was 60 mmHg. Atropine 2 mg did not produce chronotropic or haemodynamic improvement. She responded to isoprena-line (isoproterenol). Severe hypotension has been reported in another patient taking sotalol when intravenous amiodarone (total dose 250 mg) was given. Another report describes cardiac arrest in one patient on amiodarone, and severe bradycardia and ventricular fibrillation (requiring defibrillation) in another, within 1.5 and 2 hours of starting to take propranolol. ... 

Atropine, extracted from the plant Atropa belladonna, has been used in the treatment of bradycardia (low heart rate) and cardiac arrest. Draw the enantiomer of atropine ... 

A 47-year-old woman who had taken 16 g of verapamil 1 hour before was given activated charcoal 50 g orally, a noradrenaline infusion, and boluses of calcium and atropine. She had a cardiac arrest and was given boluses of calcium, glucagon, and adrenaline. Because of refractory shock she was also given levosimendan, and after 6 hours the doses of vasopressors were reduced. She gained full... 

An elderly man with long standing brady-tachycardia was successfully treated for atrial flutter firstly with a temporary pacemaker (later withdrawn) and 600 mg amiodarone daily. Ten days later, and 25 minutes after a permanent pacemaker was inserted under local anaesthesia with 15 mL of 2% lidocaine, severe sinus bradycardia and long sinoatrial arrest developed. He was effectively treated with atropine plus isoprenaline, and cardiac massage. ... 

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