• Antiarrhythmic
• Anticholinergic

• Competes with acetycholine for receptor sites blocking the PNS response at SA & AV nodes
• Increase chronotropic properties with little or no inotropic effects
• Inhibits secretions by drecreasing PNS effect on bronchial, salivary, sweat and GI glands

IV/IO 2-4 minutes

IM 10-15 minutes

Indications

Adult: Dysrhythmias (S-127)

- Unstable Bradycardia: Narrow Complex

Adult:

0.5mg IV/IO for pulse <60; MR q3-5 to max 3mg

Indications

PEDS: Dysrhythmias (S-163)

- Unstable Bradycardia: after BVM for 30 seconds and 3rd dose of Epinephrine

PEDS:

<9y/o: HR <60; 9-14y/o: HR <40

PDC IV/IO: MR x1 in 5"

Poisoning / OD (S-134, S-165)

- Symptomatic organophosphate poisoning

Adult:

2mg IV/IO/IM; MR x2 q3-5"; MR q3-5" prn BHO

PEDS:

PDC IV/IO/IM; MR x2 Q3-5"; MR q3-5" prn BHO

• None

• Tachycardia / palpitations
• Dry mouth / Nausea / Vomiting
• Pupil dilation / blurred vision
• Flushed / hot / dry skin

(Concentrations: 1mg/10ml or 0.4mg/1ml)

1. Pacing is the treatment of choice for wide complex bradycardias.  Use atropine only if pacing is unavailable (adults).
2. Use with caution for patients wiht MI (may extend infarct area).
3. Smaller doses given too slowly may produce a paradoxical slowing of the heart rate.
4. Atropine will not reverse the muscle weakness associated with OPP; 2=PAM is used.
5. May worsen bradycardia associated with second-degree type II and third degree blocks.
6. May not work with cardiac transplant patient as vagus nerve has been severed. Should begin cardiac pacing if rhythm is refractory to 1mg Atropine.