Atropine

[EDrunnerRN]

In cardaic arrest situation's I know that Atropine is fast push/slam. However, last week I had a pt who was brady and the cardiologist, who likes to push his own medications, slammed 1 mg of Atropine in the patient which resulted in a pt who was tach. I thought that 0.5 mg of Atropine would have been sufficient and I would have pushed at a steady slow rate. On a side note, I have a huge amount of respect for this cardiologist and I know this is his specialty and I am not questioning his ability in this case. What would my fellow nurses do in this situation...how fast do you push atropine in a brady patient????

[NotReady4PrimeTime, RN]

Atropine should not be "slammed". The recommended rate of administration is over 30 to 60 seconds. The only cardiac med that should be "slammed" is adenosine - to give it any other way would be the same as squirting it on the floor. Did your patient decompensate after becoming tachycardic?

[EDrunnerRN]

Maybe I shouldn't have used the word "slammed" because the amp does not allow you to slam it in. My point is...after the incident I talked to some seasoned nurses about how fast the Doc pushed the Atropine and I stated, I never push it that fast in non arrests. The overall census was to push it fast. Personally I do the full 60 seconds at a steady rate. As far as cardiac arrest I am probably guilty of pushing faster than the recommended 30-60 secs. As for the patient, the Doc pushed his own Lopressor after making him tach. He went to the cath lab shortly after....

[NotReady4PrimeTime, RN]

I'd say that in an arrest, the rate of administration is much less important. After all, dead is dead. Getting it inot the patient and circulating with high-quality compressions would be the goal there.

[PAERRN20]

I agree with you if the patient was alert and responsive 0.5mg of Atropine would have probably suffice, pushed over 30 secs of so. I will admit I am sometimes guilty of giving routine meds a little faster, so I cut the doc some slack there.

[herowneulogy, BSN, RN]

Thanks for the information, new grad here, loving the tips you all post ;p

[usalsfyre]

Atropine should be pushed quickly. One of the side effects of atropine that is potentiated by slow administration is reflex bradycardia. 0.5mgs is the standard dose for non-arrest situations, but unless the bradycardia was caused by increased vagal tone then your not going to see the atropine have much lasting effect.

[MassED, BSN, RN]

Maybe I shouldn't have used the word "slammed" because the amp does not allow you to slam it in. My point is...after the incident I talked to some seasoned nurses about how fast the Doc pushed the Atropine and I stated, I never push it that fast in non arrests. The overall census was to push it fast. Personally I do the full 60 seconds at a steady rate. As far as cardiac arrest I am probably guilty of pushing faster than the recommended 30-60 secs. As for the patient, the Doc pushed his own Lopressor after making him tach. He went to the cath lab shortly after....

code meds are always pushed fast. Period.

[GilaRRT]

Shoot, atropine has been so de-emphasised save for special situations the focus should be on the proper medicatios.

[suanna]

Profound bradycardia=very poor perfusion and tissue death/injury, and eventualy death. Transiant tachycardia=mild cardiac stress and -well-not much else. In a stress stest we are targeting a heart rate 120-140. Atropine is vagolytic-blocking the bradycardia mediated by the parasympathetic system. It does little to directly cause tachycardia. It simply relieves the force of the parasympathetic resistance to tachycardia. Given one problem is lethal, the other is transiant and inconsequential, pushing atropine quickly sometimes means saving the patient from the BIG bradycardia-asystole. The length of action is short- the tachycardia will resolve on its' own. That is why there is a max dose of Atropine. Once the vagal stimulation is fully blocked, any more is just a IV flush. If you trust this cardiologist, believe in his decision.