Atropine increases firing of the sinoatrial node (atria) and conduction through the atrioventricular node (AV) of the heart by blocking the action of the vagus nerve. With 3rd-degree block, there is a complete block and disassociation of the electrical activity that is occurring in the atria and ventricles. Since atropine’s affect is primarily on the SA node in the atria, a 3rd-degree block would prevent its affect on the SA node from influencing the rate of ventricular contraction which is needed to improve perfusion. With Mobitz-II, aka, Second-degree AV Block Type II, the situation is similar. There is a partial block in the electrical impulses from the atria (SA) to the ventricles, and thus the affects of atropine would not significantly change the status of the ventricles. This block can also rapidly progress to 3rd-degree block. To summarize, Atropine may speed the firing rate of the SA node (atria), but the ventricles are not responding to anything the atria (SA node) puts out. Thus, the heart rates will not increase. There may be some action at the AV-node with atropine, but the effect will be negligible and typically not therapeutic. Atropine in most cases will not hurt the patient with 3rd-degree block unless they are unstable and you delay pacing to give atropine. It is important to note that Mobitz II and Complete Heart Block may be associated with acute myocardial ischemia. In this case, if atropine is used and it increases the heart rate there is a high potential for worsening of the myocardial ischemia due to the increased oxygen consumption. The increased heart rate will also reduce the diastolic filling time which may worsen coronary perfusion. Since new onset mobitz II and Complete Heart Block are commonly associated with myocardial infarction, it would be ideal to keep the HR slow (50-60) to increase diastolic filling time. Anytime you increase HR, the diastolic filling time is what takes the biggest hit. Transcutaneous Pacing should be the first line in symptomatic Mobitz II and Symptomatic Complete Heart Block. It is very safe & less painful than in previous times due to technology improvements. Research has shown that most individuals can tolerate > 15min of transcutaneous pacing without too much difficulty
After applying TCP for unstable patient you can’t use carotid artery for pulse because of Spasm. You should use femoral artery pulse instead of carotid
This video is wrong. The patient is SYMPTOMATIC secondary to hypotension and should be considered for Pacing immediately. Just because they are responsive, does not mean they are stable. Please consult the algorithm....there are 5 criteria posted by AHA ACLS, which differentiate between stable and unstable. Hypotension is certainly one of them. Sure, we can push Atropine, but Pacing or Pressors would be the route to choose for this patient as you've described them. PLUS, being 2nd Degree Type 2 Block, we know that Atropine will not be effective. Pacing and Pressors are THE priority with this patient. 3rd degree block and v-fib are on the way if you don't treat aggressively.
No it's not. I'm a paramedic and this scenario was handled poorly. Due to skin being diaphoretic, pale, and cool, as well as the pt being hypotension. TC Pacing should have been prioritized over atropine. You could have avoided their decline. Be a proactive medic, not reactive.
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Atropine increases firing of the sinoatrial node (atria) and conduction through the atrioventricular node (AV) of the heart by blocking the action of the vagus nerve.
With 3rd-degree block, there is a complete block and disassociation of the electrical activity that is occurring in the atria and ventricles. Since atropine’s affect is primarily on the SA node in the atria, a 3rd-degree block would prevent its affect on the SA node from influencing the rate of ventricular contraction which is needed to improve perfusion.
With Mobitz-II, aka, Second-degree AV Block Type II, the situation is similar. There is a partial block in the electrical impulses from the atria (SA) to the ventricles, and thus the affects of atropine would not significantly change the status of the ventricles.
This block can also rapidly progress to 3rd-degree block.
To summarize, Atropine may speed the firing rate of the SA node (atria), but the ventricles are not responding to anything the atria (SA node) puts out. Thus, the heart rates will not increase.
There may be some action at the AV-node with atropine, but the effect will be negligible and typically not therapeutic. Atropine in most cases will not hurt the patient with 3rd-degree block unless they are unstable and you delay pacing to give atropine.
It is important to note that Mobitz II and Complete Heart Block may be associated with acute myocardial ischemia. In this case, if atropine is used and it increases the heart rate there is a high potential for worsening of the myocardial ischemia due to the increased oxygen consumption. The increased heart rate will also reduce the diastolic filling time which may worsen coronary perfusion.
Since new onset mobitz II and Complete Heart Block are commonly associated with myocardial infarction, it would be ideal to keep the HR slow (50-60) to increase diastolic filling time. Anytime you increase HR, the diastolic filling time is what takes the biggest hit.
Transcutaneous Pacing should be the first line in symptomatic Mobitz II and Symptomatic Complete Heart Block. It is very safe & less painful than in previous times due to technology improvements. Research has shown that most individuals can tolerate > 15min of transcutaneous pacing without too much difficulty
YES! THAT. NO ATROPINE.
Thank you
@@jenniferreed1636 I have bradycardia
Please edit the video ⚠️
if there is no pulse AHA 2020 guidelines recommends starting immediately with cpr
After applying TCP for unstable patient you can’t use carotid artery for pulse because of Spasm. You should use femoral artery pulse instead of carotid
This video is wrong. The patient is SYMPTOMATIC secondary to hypotension and should be considered for Pacing immediately. Just because they are responsive, does not mean they are stable. Please consult the algorithm....there are 5 criteria posted by AHA ACLS, which differentiate between stable and unstable. Hypotension is certainly one of them. Sure, we can push Atropine, but Pacing or Pressors would be the route to choose for this patient as you've described them. PLUS, being 2nd Degree Type 2 Block, we know that Atropine will not be effective. Pacing and Pressors are THE priority with this patient. 3rd degree block and v-fib are on the way if you don't treat aggressively.
Very helpful...big up!
I’m here crying because my college didn’t even show me the devices that i need to work with
this is one of the most helpful video in youtube, thanks
No it's not. I'm a paramedic and this scenario was handled poorly. Due to skin being diaphoretic, pale, and cool, as well as the pt being hypotension. TC Pacing should have been prioritized over atropine. You could have avoided their decline. Be a proactive medic, not reactive.
Is it 0.5 mg or 1 mg?
Liberally Apply 8” of chitterlings wrench to grandma , then douse in essential oils freely.
I didn't think Atropine was given in a block? Am I wrong?
It is considered if it is type 1 or first type of type 2
Fun Dungeon I agree with you.
The patient is unstable due to hypotension
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