Pediatric Question

[Miramedic]

I understand why we don't give atropine to infants. However, I don't understand why we don't give atropine in asystole to pediatrics. Can someone please explain.

Thanks

 

[DT4EMS]

I understand why we don't give atropine to infants. However, I don't understand why we don't give atropine in asystole to pediatrics. Can someone please explain.

Thanks

The main reason for not giving atropine is the pediatric arrest is secondary to an airway problem. Atropine is given to block the Parasymathetic..........peds don't "usually" have a problem with vagal tone.

Therefore Epi is the drug of choice after aggressive airway and oxygenation.

Atropine can be given to peds where true vagal stimulation is the culprit.

 

[FFEMT1764]

Atropine can be given to peds where true vagal stimulation is the culprit.

Unless you local protocols say otherwise...and I thought that the AHA removed atropine from the pedi guidelines with the new update...

 

[DT4EMS]

Atropine is not in the arrest Algorithms but is still in the Brady IF you suspect a true vagal tone or primary AV block.

 

[FFEMT1764]

That's what I thought, but our protocols say no no to atropine in peds...I guess the doc wants the better safe than sorry approach.

 

[Miramedic]

The main reason for not giving atropine is the pediatric arrest is secondary to an airway problem. Atropine is given to block the Parasymathetic..........peds don't "usually" have a problem with vagal tone.

Therefore Epi is the drug of choice after aggressive airway and oxygenation.

Atropine can be given to peds where true vagal stimulation is the culprit.

Thanks for the reply but, if a child is in asystole what could be the detrimental outcome of administering atropine if any?

 

[jeepmedic]

Thanks for the reply but, if a child is in asystole what could be the detrimental outcome of administering atropine if any?

I think this is one for Ridryder.

 

[DT4EMS]

Thanks for the reply but, if a child is in asystole what could be the detrimental outcome of administering atropine if any?

According to the AHA, a vagolytic dose can be considered, but there is just no proof it is of benefit. Again pediatric codes that get to asystole have a very poor prognosis.

The main focus has to be on prevention.....via aggressive O2 therapy and finding reversible causes.

 

[Ridryder911]

Ditto..anticholinergics do not appear to respond and work as well in pediatric arrest due to conduction system is not usually the problem. As well pediatrics are highly vagolytic (hence premedicate with Atropine prior to RSI) ever seen a kid hold their breath and pass out?, However; small doses of Atropine may cause paradoxical bradycardia. Some may use Atropine in resuscitation measures in "special consideration". Especially those with high vagal responses, and bradycardia (prior to arrest /0.02mg/kg), organophosphate poisonings (higher dosage).

I believe it is not so much that Atropine will cause harm, as much as it has been demonstrated not to change or produce + benefits. As Dt4EMS and others describe predisposition of respiratory disorders, poor pulmonary/ capillary (oxyhemoglobin) perfusion, from what most pediatric arrest occurs.

Oxygenation definitely needs to be addressed thoroughly and be sure it is corrected as well.