Asystole question

[dochubert]

Can someone explain to me the reasons for using atropine in a patient who is in asystole.The Kaplan books say the protocol includes the use of epinephrine and atropine.

Thanks.

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[stoic]

premed responding here, so take my info with a grain of salt:

As I recall from physiology class, atropine is a competative antagonist of muscarinic cholinergic receptors. Its use during asystole would be to make sure that there was no parasympathetic stimulation blocking the establishment of a normal sinus rhythm.

 

[Seaglass]

As I recall from physiology class, atropine is a competative antagonist of muscarinic cholinergic receptors. Its use during asystole would be to make sure that there was no parasympathetic stimulation blocking the establishment of a normal sinus rhythm.

This is correct. You are trying to increase conductance of the AV node.

 

[Apollyon]

Indeed; for that same reason, that is the reason that you don't shock asystole. Many people (like field paramedics) will shock asystole, saying, "What can it hurt?". If it some old man or woman, that is in asystole after a profound parasympathetic discharge while straining on the toilet, and you shock them, you have killed them, when atropine possibly could have saved them.

This is from the ACLS text 2 books ago (before it was in color).

 

[Seaglass]

If it some old man or woman, that is in asystole after a profound parasympathetic discharge while straining on the toilet,

Interesting, we have a patient on the medicine service with just that complaint who had a + tilt table test. He is known to "code" frequently.

Just FYI, when you have a patient who responds to the question "Do you have any other medical problems?" with "I code all the time," you may want to look into that further.

C