Pediatric RSI Trauma Atropine?

Specialties Emergency

Published

Specializes in Emergency Nursing (CEN).

Good afternoon all! I've been an ER nurse for 3 years now, have worked in several ER's and most recently moved to an ER that receives trauma. Last case was a 1 year old that had her head run over by a car. Basilar skull fracture, depressed occipital fracture was seen on the CT. When she arrived we moved quickly to intubate. My doc order succhs, etomidate and atropine for induction. I've found conflicting literature online about use of atropine to combat bradycardia from vagal stimulation in peds. Curious as to what others experiences are. Do your docs use it? Thanks in advance for your time and any peds trauma tips are welcome as this is a whole new world for me. TNCC helps, but reality is scary!

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Specializes in NICU, ICU, PICU, Academia.

Don't do trauma (yet) but our PICU routinely at least draws up atropine for RSI. I would say about 25% of the time do we actually have to give it.

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Specializes in ER, Neuro, Trauma, Educator.

I just got back from the American Heart Association Guidelines update in Florida. One of the new updates for PALS & ACLS is that they no longer support the routine use of atropine for intubation. It may just depend on the physician, facility, pt condition, etc. though but good for you for looking into something that wasn't practice you were familiar with! I'm trying to get better about doing that! Anyways, check on the AHA website as I think the new guidelines are posted and you may find a better answer to your question. Good luck and let us know what you find out! :)

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A 2007 review article in Emergency Medicine Journal reevaluating the use of atropine in pediatric RSI revealed that no evidence supports the routine use of atropine to decrease the incidence of bradycardia.5 Further, atropine complicates an already high-stress environment of pediatric RSI, while also having the potential to induce dysrhythmias. Atropine has now fallen out of favor as a pretreatment agent.1

Source: Rapid Sequence Intubation Pharmacology - Page 6 of 6 - ACEP Now | Page 6

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Not a routine intubation at all. Definitely a risk of prolonged laryngoscopy and desaturation because of disrupted anatomy and in line stabilization of the c-spine. Atropine would preempt reflexive Bradycardia and arrest from hypoxia.

Very defensible.

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Not a routine intubation at all. Definitely a risk of prolonged laryngoscopy and desaturation because of disrupted anatomy and in line stabilization of the c-spine. Atropine would preempt reflexive Bradycardia and arrest from hypoxia.

Very defensible.

Nice comment, and good on OP for doing research. Not every case is routine (obviously), so remember that the physician has the right to deviate from protocols if they are attempting to do right by the patient. Don't be that person in the corner losing it if ACLS isn't being followed to a T if you don't really really have a handle on the situation; you could very well not know whats going on and be wrong.

New RNs and medics that work in my ED get burned on this sometimes. We are a mega center that gets all kind of cases with 24/7 residency-trained pharmacists on the floor etc etc, so this kind of stuff happens often enough.

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