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Case Study: Atropine & the Bradycardia Patient

Atropine is one of the oldest drugs in the medical pharmacopeia. It was used in ancient times, not as a chronotropic agent, but as a cosmetic drug. The belladonna plant, which is a source of atropine, means "beautiful lady" in Italian. It was known for its ability to redden cheeks and dilate the pupils, thereby enhancing beauty. Atropine has also been a first-line treatment for bradycardia for hundreds of years. In modern times it is used to antagonize the effects of acetylcholine, which plays a large role in regulating the sinoatrial node and transmission of impulses to the atrioventricular node in the heart. It is accepted practice to treat bradycardias with SA nodal input by giving atropine.…

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 Remember Atropine for “Killer B's”

Muscarinic symptoms can be remembered by the mnemonic DUMBELS, which is an acronym for Diarrhea, Urination, Miosis, Bronchospasm/bronchorrhea/bradycardia, Emesis, Lacrimation, and Salivation/sweating/secretion. Atropine is a muscarinic agonist and is able to reverse muscarinic symptoms. Atropine is especially useful when facing high-risk symptoms like bronchorrhea and bradycardia (killer B's).

Articles of Interest

ACLS Guidelines – Atropine, Adenosine & Therapeutic Hypothermia

Atropine for Asystole: not recommended in asystole and PEA anymore, not due to negative studies, but rather to the realization that the evidence was always weak and therefore shouldn’t be considered positive. Atropine for Bradycardia: may increase ischemia in the setting of an MI, doesn’t work in transplant patients and is unlikely to work in patients with 2nd degree type II and 3rd degree block

Atropine Not Needed for RSI

This is a complicated process, which is not made easier by adding additional medications, especially, when that added medication may lead to a dose calculation error, adverse side effect, or mask of more important causes of bradycardia. For these reasons, atropine is not be routinely needed as a part of RSI.

Epinephrine vs. atropine for bradycardic periarrest

There aren't any prospective RCTs comparing atropine vs. epinephrine for bradycardia. In the absence of such evidence, the following is an argument for choosing epinephrine.

How to Use Low-Dose Atropine to Slow Myopic Progression in Kids

Because of growing concern about pathological myopia, re­cent research studies focused on slowing progression of garden-variety myopia in children have garnered interest among ophthalmologists. Low-dose atropine (0.01%) has emerged as an effective approach, as highlight­ed by the Atropine in the Treatment of Myopia studies (ATOM1 and ATOM2).

Initial Dose of Intravenous Atropine for Patients With Symptomatic Bradycardia　― A Scoping Review ―

This scoping review highlights a critical lack of evidence supporting the use of a specific initial dose of intravenous atropine for the treatment of symptomatic bradycardia. We found no comparative studies of 0.5 mg and 1 mg, so the optimal dose could not be determined; however, no differences were found in efficacy or worsening of bradycardia in the studies of each dose.

Is Atropine Necessary for Cardiopulmonary Resuscitation?

The combination therapy of atropine and epinephrine during CPR showed poor neurological outcome compared with epinephrine alone. Atropine is not useful for adults with non-shockable rhythm in terms of 30-day neurological outcome.

Treatment of Bradycardia and Bradydysrhythmias

What are the latest recommendations about dosing of atropine and when is atropine likely to be detrimental?

Unstable Bradycardia

Doesn’t hurt to try, may work: .5mg IV, can be repeated q3min to a max dose of 3mg. · If atropine is not working, high probability it wont, then start transcutaneous pacing while getting chronotropic medication (pressors) ready and then titrating to desired effect

Resources

StatPearls

Atropine is the first-line therapy (Class IIa) for symptomatic bradycardia in the absence of reversible causes. While atropine can be used independently for anti-salivation effects, it most commonly is secondary to anticholinergic or antimuscarinic poisoning.