I had a patient who had a very low heart rate, between 37 and 45. Heart rate hung around the 40's most of the day. His blood pressure however, was about 160-190 systolic. We fixed the heart rate and blood pressure by the end of the shift, with a mix of HD, hydralazine, and enalapril. He was also on a versed drip for agitation, and it helped the BP.
Anyway, my question is when do you give atropine? I know it is given for low heart rate but how low is low? I thought my pt's heart rate warranted some atropine, but I was told to hold off if he maintained his blood pressure, which he did so I never got o give it. Does that mean that atropine should be given if the patient is symptomatic and his/her VS are deviating from the baseline? This patient was sedated and very unresponsive, would the BP be the only thing to guide me?
His HR really worried me, I did sternal rub a couple of times and it helped fix the HR for a little bit. One of the MD's suggested it may have somnething to do with cerebral edema (we went for CT scan, no results by end of shift. Pupils reactive). I was too busy to sit with him and pick his brains, anyone care to explain?
All answers are more than welcome, thank you in advance.
Sep 8, '08
You are right Love, only give it if the pt is symptomatic. It can be a little nerve racking to have a hr around 30-40, but if the pt is compensating accordingly no need for meds. However treating the cause if in fact it was elevaed icp's may be an option. It sounds like he could have had increased icp's. Agitation and change in LOC are classic signs.
If you have a pt in complete heart block you need a pacer. Antropine works on the SA node, and since there isn't any comunication between the atrium and ventrical you could cause more trouble. Another interesting note that I just learned is atropine isn't affective in heart transplant pt's because the conduction system isn't intact.
Last edit by Soonstudent on Sep 8, '08
Lifelongstudent, you say you are not bashing and I believe you. But to answer your question about why I do not know basic ICU nursing or why Cushing's triad was not covered in my nursing education, did I say it was not covered in nursing school? Unfortunately, I do not have a super memory and I do not remember everything, that's why I research, ask questions, and still study. And about me not having covered it in my training, I am still on orientation. Thanks for your concerns.
Last edit by love-d-OR on Sep 15, '08