teedubbyaw
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Haven't read a single thing in this thread, but why the heck would you push atropine on a 'severely hypotensive, bradycardic' ROSC pt? That's silly.
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Haven't read a single thing in this thread, but why the heck would you push atropine on a 'severely hypotensive, bradycardic' ROSC pt? That's silly.
Looks like he was replying to a symptomatic brady patient post rosc. usaf gave him that scenario in the post or two before.
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Let's keep it civil and polite. I had to start swinging the ban stick on Halloween.
gotbeerz001
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I had made an attempt to edit my post but was on a call and hit the 10-minute edit wall. Is there a thought to allow edits beyond the 10-minute window to account for "repliers remorse"?
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Yes, you can become a Premium Member which allows you up to a week to edit your post.
http://emtlife.com/pages/membership/
gotbeerz001
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I see what you did there. [emoji106]
avdrummerboy
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I am old enough, and I am an ambulance DRIVER lol. PA? Naw, I like the field too much for that!!
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What's silly about treating severe bradycardia?
teedubbyaw
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Giving atropine to an unstable pt who has ROSC after a presumed STEMI is silly.
Deja vu, I already said that.
avdrummerboy
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The fact that it's ROSC doesn't change the current condition!
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TransportJockey
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I would personally pace a bradycardic unstable rosc patient... but thats just me
teedubbyaw
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Using an algorithm to make decisions for you isn't the best practice. Please do tell me how administering a drug that causes increased myocardial oxygen demand/workload is beneficial in a patient that just experienced ROSC after a complete occlusion?
avdrummerboy
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Any pt. with symptomatic brady can be considered unstable. If that's the case, you should never give atropine.
If it's a complete occlusion, noting you do in the field will help either way, it's a lost cause, nothing short of PCI is going to be of any help, so the question is pointless. If it's not a complete occlusion, then it's dealers choice I guess, atropine/ pacing, diesel bolus to the hospital!
If it's a complete occlusion, noting you do in the field will help either way, it's a lost cause, nothing short of PCI is going to be of any help, so the question is pointless. If it's not a complete occlusion, then it's dealers choice I guess, atropine/ pacing, diesel bolus to the hospital!
teedubbyaw
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You still seem to be missing critical points. Atropine and TCP are completely different methods of treating bradycardia. To say that ROSC doesn't matter, that bradycardia is bradycardia, and nothing you do in the field matters is completely ignorant.
avdrummerboy
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I guess it depends on area, our protocols call for atropine before pacing unless atropine is contraindicated. I didn't say that nothing that you do is pointless, but since you said that it was a complete occlusion, then only PCI will help it, pacing, atropine, dopamine, none of that will clear the blockage and get or keep the heart going.
teedubbyaw
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So you won't go out of your protocols if it means the patients best interests are in mind?
avdrummerboy
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Unfortunately, going out of protocols is how lawsuits and disciplinary action happens.
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No one is talking about slamming a mg of atropine and rocketing the HR up to 120. That would be bad. I'd start with 0.2 mg and try to increase the HR by 20-30.
"Severe hypotension" will do far more to compromise MV02 balance than increasing the HR from the 30's to 60's....not to mention the brain and kidneys. You can debate pacing vs. atropine, but the fact is you need to increase MAP, and atropine is simply easier and may do the trick just fine.
There may be a better therapy than atropine, but without seeing an EKG and an echo, I think the safe bet is increasing the HR and if that doesn't increase MAP, then try something else. Once you get the HR up, you can give neo or vaso to increase DBP, if it's low. Or if CO is the problem, you can try something that gives some squeeze.
Bottom line is, you can't ignore "severe hypotension".
teedubbyaw
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I'd rather pace, but that's just me.