Atropine Sulphate Flashcards
What is the presentation?
1.2mg in 1ml plastic vial
How does it work and what does it do?
An anticholinergic agent that inhibits the action of acetylcholine on post ganglionic nerves at the neuroeffector site. This blocks vagal stimulation to allow the sympathetic response to increase pulse rate by increasing SA node firing rate, and increasing the conduction velocity through the AV node.
An antidote to reverse the effects of cholinesterase inhibitors such as seen with organophosphate poisoning.
What are the indications?
ymptomatic Bradycardia, haemodynamically unstable due to the bradycardia and associated with poor signs of perfusion, including:
Hypotension
Altered conscious state
Diaphoresis
Shortness of breath, and/or cyanosis
Syncope
Organophosphate poisoning with cholinergic effects
What are the contraindications?
Known hypersensitivity.
Third-degree atrioventricular (AV) block.
Patients with cardiac transplant.
What are the precautions?
Isolated Bradycardia or link to traumatic cause is not an indication for atropine. All reversible causes should be addressed prior to consideration of Atropine.
It is advisable that a 12 Lead ECG is conducted prior to medication administration to rule out Acute Myocardial Infarction (STEMI) and Third-degree atrioventricular (AV) block.
Bradycardia in children is usually a result of hypoxia or vagal stimulation. Ensure all reversible causes addressed and consider commencing resuscitation as per CPG if unresponsive.
Atropine may affect patients with glaucoma.
The maximum dose of Atropine that has shown to produce the desired effect in healthy adults is up to 3mg for bradycardia. In organophosphate poisoning: atropinisation might require significant repeat dosages and is achieved when with an increased HR, dilated pupils and decreased secretion, do not delay transport as atropinisation might not be achievable in the pre-hospital setting
What dose is required in symptomatic bradycardia?
Dilution: None
Adult: 0.6mg in 0.5ml IV/IO every 3-5 minutes titrated to effect. Maximum dose 3mg
Paediatric: consult with ASMA
What dose is required in organophosphate poisoning?
Dilution: Dilute 1.2mg/1ml with 11mL saline for 1.2mg/12mL (100mcg/mL)
Adult: 1 - 2mg (10-20mL) IV/IO, repeat every 5 minutes until atropinisation is evident
Paediatric: 0.02mg/kg IV/IO, repeat every 5 minutes until atropinisation is evident
What are the side effects?
Tachycardia and/or palpitations Dilated pupils and/or blurred vision Dry mouth and/or urinary retention Confusion, restlessness (large doses) Hot, dry skin (large doses)
