Indications
-
Sinus Bradycardia (see Sinus Bradycardia, [[Sinus Bradycardia]])
- Advanced Cardiac Life Support (ACLS) (see Advanced Cardiac Life Support, [[Advanced Cardiac Life Support]])
-
Asystole (see Advanced Cardiac Life Support, [[Advanced Cardiac Life Support]]): atropine may be beneficial
-
Second Degree Atrioventricular Block-Mobitz Type II (see Second Degree Atrioventricular Block-Mobitz Type II, [[Second Degree Atrioventricular Block-Mobitz Type II]]: atropine is not effective (may slow heart rate)
- Atropine-induced increase in SA nodal firing will be partially blocked and not be conducted to ventricle
-
Organophosphate Intoxication (see Organophosphates, [[Organophosphates]]): larger atropine doses may be required
-
Third Degree Atrioventricular Block/Complete Heart Block (see Third Degree Atrioventricular Block, [[Third Degree Atrioventricular Block]]): atropine is not effective (may slow heart rate)
- Atropine-induced increase in sino-atrial nodal firing will be completely blocked and not be conducted to ventricle
-
-
Cholinergic Intoxication
- Toxic Mushrooms (see Toxic Mushrooms, [[Toxic Mushrooms]])
Contraindications
- Bradycardia in Heart Transplant Patient: atropine is ineffective, as heart transplants lack vagal innervation
- Bradycardia Associated with Hypothermia (see Hypothermia, [[Hypothermia]]): it is recommended to avoid atropine
Pharmacology
- Anti-Cholinergic: vagolytic (inhibits vagal effect)-> increases sino-atrial (SA) nodal firing (with minimal effect at the atrio-ventricular/AV node)
Clinical Efficacy
- xxxx
Metabolism
- xxxx
Administration
- IV (During ACLS): 0.5-1 mg IV q3-5 min (Max: 3 mg IV)
- Doses <0.5 mg IV may paradoxically slow heart rate
- IV (Organophosphate Intoxication) (see Organophosphates, [[Organophosphates]]): larger doses (2-4 mg IV) may be required
- ETT (During ACLS): 2 mg in 10 ml normal saline
Dose Adjustment
- Hepatic
- Renal
Adverse Effects
Cardiovascular Adverse Effects
- Increased Myocardial Oxygen Consumption: cautious use in the setting of myocardial ischemia/infarction
- Sinus Tachycardia (see Sinus Tachycardia, [[Sinus Tachycardia]])
Other Adverse Effects
- xxx
- xxx
- xxx
References
- xxx