Drugs: Atropine Sulfate

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Atropine Sulfate:

CLASS

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Anticholinergic: Atropine increases firing of the sinoatrial node (SA) and conduction through the atrioventricular node (AV) of the heart by opposing the actions of the vagus nerve. It blocks acetylcholine receptor sites, and decreases bronchial secretions.

A common mnemonic used to describe the physiologic manifestations of atropine overdose is: "hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter".[6] These associations reflect the specific changes of warm, dry skin from decreased sweating, blurry vision, decreased sweating/lacrimation, vasodilation, and central nervous system effects on muscarinic receptors, type 4 and 5. This set of symptoms is known as anticholinergic toxidrome, and may also be caused by other drugs with anticholinergic effects, such as diphenhydramine, phenothiazine antipsychotics and benztropine.[7]

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Atropine Sulfate

ROUTE

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Rapid IV push

ETT alternate route

IM (nerve agent only; refer to 2-PAM Chloride kit)

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Atropine Sulfate

ADULT DOSE

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ADULT: PEA or Asystole: 1 mg IV push (maximum total dose - 0.04 mg/kg)

Symptomatic bradycardias: 0.5 to 1 mg IV push (maximum total dose of 0.04 mg/kg)

Organophosphate poisoning: 2 mg IV push every 5 to 15 minutes until excessive secretions are diminished.

Nerve Agents: 2 to 20 mg IM or IV push (refer to 2-PAM Chloride kit)

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Atropine Sulfate

PEDIATRIC DOSE

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Symptomatic bradycardias: 0.02 mg/kg, (minimum single dose - 0.1 mg) IV Push.

PEA and Asystole: not used in the prehospital setting

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Atropine Sulfate

DRUG ACTION

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Reverses suspected vagal tone in bradycardias, asystole, and PEA.

Bloskc acetylcholine in organophosphate poisonings

Reverses effects of nerve agents

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Atropine Sulfate

INDICATIONS

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Symptomatic bradycardias

Asystole

Rates less than 60 in PEA rhythms

Organophosphate poisoning

Chemical exposure due to nerve agents

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Atropine Sulfate

PRECAUTIONS

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To avoid transient bradycardias, administer rapidly and in the port closest to the IV site.

Notify Biotel prior to administration if patient has a history of glaucoma, prostatic hypertrophy, or bladder neck obstruction.

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Atropine Sulfate

SIDE EFFECTS

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Tachycardia

Dilated pupils (may make pupil assessment unreliable)

Anticholinergic effects: dry mouth, blurred vision

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Atropine Sulfate

CONTRAINDICATIONS

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Hypothermic bradycardia, PEA and asystole prior to rewarming