Emergency drugs in radiology - All about Atropine
Physiology:
Parasympathetic nervous system -
Quiet "rest and digest" situation - purpose is conserve energy
Neurotransmitter: Acetylcholine and acts on muscarinic receptors
What does stimulation of parasympathetic system does:
1. Eye: Miosis
2. Heart: Reduced heart rate and velocity of conduction through AV Node
3. Vasculature: Vasodilation
4. Lungs: bronchoconstriction and increased secretions
Main nerve: Vagus
Supplies the heart, digestive system, respiratory system (breathing)
Vagal response (vasovagal attack):
Vagus nerve to the heart overreacts
- Reduced BP and bradycardia
- Suppress respiration
- Pooling of blood in the lower limbs
Atropine:
Alkaloid, made from atropa belladonna
Type: Muscarinic antagoinst, competes with acetlycholine to block the muscarinic receptors
Effects when given during vagal shock: tachycardia, bronchodilatation, increase BP and reduces secretions
Common adverse effects: Blurred vision, photophobia, tachycardia, flushing and hot skin
Dosage for vagal reaction: 0.5 mg to 1 mg i.v
Preventive administration during procedures: Not recommended
Situation in Radiology room:
Eg. Severe pain during interventional procedure triggering vagal shock
Situation 1: Bradycardia and low BP - reassure, leg raising and monitor. If not improving atropine i.v may be given
Situation 2: Cardiac arrest - CPR
Real life experience:
Patient collapsed while doing thoracentesis and went into cardiac arrest: CPR was given and patient immediately revived. Simultaneously code "blue" was called and the "emergency" team took over.
Share you experience about atropine use in a real life situation, in the comment section
References
1. https://www.ncbi.nlm.nih.gov/books/NBK553141/
Prepared by: Dr. Sharad Maheshwari
Published: 14.10.2022
Updated: 18.10.2022
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