Bradycardia, Organophosphate poisoning, Asystole, Adult Beta Blocker overdose..
Potentially Lethal Side Effects:
tachycardia, paralitic ileus
Hypersensitivity to belladonnas, angle closure glaucoma, GI obstruction, myasthenia gravis, thyrotoxicosis, ulcerative colitis, prostatic hypertrophy, tachycardia, asthma, acute hemorrhage, hepatic disease, myocardial ischemia
Asystole:
IV bolus: 1mg q 3-5min to max 0.03-0.04mg/kg
Bradycardia*:
Rapid IV: 0.5-1mg Max 2mg
Symptomatic Organophosphate Poisoning** #:
Rapid IV: 2-4mg;
IM 2-4mg 1:1000 if no IV access*
Interval is q 5 min until atropinization occurs
Beta Blocker overdose with symptomatic bradycardia:
Rapid IV: 1mg
Asystole (PALS):
Not used in pediatric asystole.
Bradycardia (PALS)*:
IV/IO Rapid push 0.02mg/kg with flush. Minimum dose 0.1mg;
Max single dose for child = 0.5mg
Max single dose for adolescent = 1mg
Symptomatic Organophosphate Poisoning** #:
IV/IO Rapid push 0.05mg/kg with flush.
Subsequent doses doubled q 5 min until signs of atropinization occur.
* Slow IV administration of Atropine can produce reflexive bradycardia
** Protocols vary among locales. Check local protocols.
# Signs of atropinization include pupillary dilation, tachycardia, flushing, deminished diaphoresis, and drying of secretions.
- Atropine will not reduce respiratory depression caused by organophosphate poisoning, as the drug works by action on muscarinic receptors, and not the nicotinic receptors affected during organophosphate poisoning which are responsible for ventilatory muscle use.
Some organophosphates include:
(Highly toxic): Tetraethyl pyrophosphate, Phorate, Parathion, Disulfoton;
(Moderately toxic): Coumaphos, Chlorpyrifos, Trichlorfon, Ronnel;
(Mildly Toxic): Diazinon, Malathion, Vapona, Acephate.
Some beta blockers include:
Inderal, Lopressor, Tenormin, Corgard, Blocadren, Cartol, Visken, Sectral, Normodyne, Trandate, Betapace, Zebetl, Metropolol.