ACLS drugs for Bradycardia | ACLS-Algorithms.com

Comments

  1. Dr Sarat says

    What about use of epinephrine infusion for bradycardia caused of acute iwmi?
    Is it contraindicated in such scenarios?

    • ACLS says

      Epinephrine is not contraindicated in such situations. Epinephrine infusion may be used. Epinephrine and dopamine infusions may be used in certain situations like this to maintain adequate cardiac output, but they are not routinely administered to manage complete AV block in a non-perfused acute inferior wall myocardial infarction.

      Kind regards,
      Jeff

    • ACLS says

      Isoprenaline (Isuprel) is not recommended within the AHA ACLS guidelines for treatment within the bradycardia algorithm. Kind regards, Jeff

      • ACLS says

        Bring the bradycardia algorithm food next door there would not be any common reason to deviate from the guidelines.
        Kind regards, Jeff

  2. Jackie says

    What reasoning/evidence was used in the recommendation for increasing the atropine dose to 1mg instead of 0.5mg?

    • ACLS says

      I’m sorry I can’t be more helpful with this answer. I wish I knew the answer to it, but the American heart Association has not made any information about this change readily available in their literature.

      I am continuing to work on updates on the site and as soon as I get these complete, I will be doing a deep dive into this to see if I can determine what the scientific

      Kind regards, Jeff

    • ACLS says

      The total dose should be restricted to avoid Atropine-induced tachycardia, increased myocardial oxygen demand and the potential for worsening cardiac ischemia or increasing infarction size.
      Kind regards, Jeff

  3. James Matthew says

    Hi. Please, what is broad complex bradycardia? In the treatment of this- is atropine effective and why?

    • ACLS says

      Atropine works by poisoning the vagus nerve, thereby removing parasympathetic inputs to the heart. This works beautifully for vagally-mediated bradycardia (e.g. vagal reflexes, cholinergic drugs). However, it fails for bradycardias caused by other mechanisms (e.g. heart block beyond the AV node). Overall, atropine is completely effective in only 28% of patients with symptomatic bradycardia.

      Kind regards,
      Jeff

    • ACLS says

      It’s not that it has to be administered every 3 to 5 minutes. It should repeated every 3 to 5 minutes if there is no response to the previous doses. If an increased and adequate heart rate is achieved then it does not need to be repeated.

      The half-life of atropine is 20 to 30 minutes

      The reason for waiting 3 to 5 minutes before repeating is to ensure that you have adequately circulated the previous dose and are seeing a complete response to that dose.

      Kind regards,
      Jeff

    • ACLS says

      Atropine can have a positive effect for reducing junctional escape rhythms caused by bradycardia. Atropine is used sed to increase heart rate through vagolytic effects. This increase in heart rate reduces junctional escape rhythm’s because of the improved heart rate. Kind regards, Jeff

    • ACLS says

      There is no specific role. If a patient had symptomatic bradycardia with an underlying atrial fibrillation then atropine would be used for the treatment of the bradycardia. This would be the same whether or not the patient had underlying atrial fibrillation.

      I hope that answers your question. If you have any further questions, please let me know.

      Kind regards,
      Jeff

      • Chris says

        Had a patient recently with bradycardic a-fib with a ventricular response rate of around 32 bpm. Said she had a sync opal episode after using bathroom. Atropine works wonderfully for this as this is what it was designed for. I gave 0.5 mg instead of 1.0 mg but it still was very effective for about thirty minutes.

  4. Kathryn says

    I teach both ACLS & PALS and the Epi vs. Atropine debate has always bothered me. We used to use Epi for adults with Symptomatic Bradycardia and Epi is still included for pediatric Symptomatic Bradycardia. Why did they remove Epi from the adult algorithm? By the way, your site is extremely helpful.

    • Jeff with admin. says

      For bradycardia in adults, one of the primary causes is myocardial injury/ischemia. IV push epinephrine may cause too profound of an increase in heart rate and further compromise myocardial function, and the patient could have complications. I believe that’s why epinephrine was removed from the bradycardia algorithm.

      Since myocardial injury/ischemia is not typically a problem which causes bradycardia in children, I believe this is why they have continue to use epinephrine in the pediatric bradycardia.

      Kind regards,
      Jeff

      • Dennis Ray Kirby, Jr says

        I’m a now retired paramedic, I always had great success with low dose dopamine for SYMPTOMATIC bradycardia non-responsive to atropine. I always preferred it due to not increasing so much the heart workload. Again, with great results. Too bad I didn’t have a PhD, maybe I could have written a paper that would have changed things…..like giving atropine, not giving it, now giving it again….bicarb, etc….lol.

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