Atropine or Adrenaline

[tethys]

Hi all,

It's my first time to post. and I need your opinion. let's see the scenerio.

An intubated patient, on ventilator and was agitated even on sedation. bitting the ET tube, causing severe bradycardia with a BP dropped to 50 something. his airway was then clear. what medication should be given first? Atropine to reverse his HR or Adrenaline to top up the BP?

I refered to the ACLS guidelines, stated to give Atropine first in brady. if got severe signs & symptoms.

But I think why isn't Adrenaline, faster to top up the BP and also has the beta effect to increase HR.

What's your opinions?

[rjflyn, ASN, RN]

Neither. Sounds like the pt vageled down to that rate. If the patient stops fighting then the rate and Bp generally correct without treatment. After that appropriate sedation/paralytic needs to be considered. You know A,B, then C.

Rj

[ZASHAGALKA, RN]

You can give atropine to correct the vagal bradycardia, if it's symptomatic. This is why we normally have atropine on standby when pulling sheaths.

Epi isn't indicated because the low BP IS A RESULT OF the bradycardia. Fix the bradycardia and the bp should correct.

It's a question of which is causing which. If the low bp was causing the bradycardia, then epi might be the choice drug (although we normally use volume, dopamine, neo or levophed first. At least where I work, epi is not a frontline pressor. If you can effectively use a handgun, you hold the cannons in reserve.)

But since the low bp is caused by the bradycardia, atropine is the first choice. Although, as the previous poster said, using sedation and probably, in this case, paralytics to stop the vagal process in this struggling patient is also priority. If you use atropine, you only want to use 1/2 to 1 amp, until the vagal reaction is fixed. The atropine would only be a stopgap measure. FIXING THE VAGAL REACTION IS THE PRIORITY. In this case, that calls for a paralytic or sufficient sedation. And of course, paralytics require concomitant sufficient sedation.

Epi might have a side effect of increasing hr, but you want a drug that has that as its PRIMARY effect, since that is the problem. If your bp remains low after your hr comes up (because now you have lots of sedation on board), then you can temporarily consider a pressor, but as I said, at least where I work, epi isn't the first choice for that.

~faith,

Timothy.

[JiffyGriff]

Haven't had ACLS yet but I was thinking the same thing they were before I read their posts........sedate them to get them to stop biting that ET then everything should correct.........if it doesn't then go to the acls meds. If you went straight for the atropine and got the heart rate increased, then got them to stop fighting the et tube there might be a rebound, then your stuck bringing the heart rate back down.

Just another question since I'm still learning here? the patient had a vagal response from gagging right? and if they weren't gagging and just causing hypoxemia from biting the tube then their HR would increase right?

[tethys]

Thanks for all of your opinion.:)