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Gewt92 t1_iug14hi wrote

Reply to comment by I-goes-to-eleven in TIL: Asthmador was an asthma treatment in the US in the 1950s. It was made up of 3 toxic/hallucinogenic compounds belladonna (atropine), stramonium (nightshade/jimson weed), and potassium perchlorate (oxidant commonly used in fireworks). One common delivery method for Asthmador - cigarettes! by Geek_Nan

I have it on my ambulance but don’t use it that often.

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I-goes-to-eleven t1_iug1jrr wrote

I use it regularly for chemical stress echos to get patients to target heart rate along with dobutamine. Occasionally in a code situation.

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Gewt92 t1_iug1vui wrote

Why are you using atropine in a code?

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I-goes-to-eleven t1_iug2j1b wrote

Severe bradycardia usually. I feel like you should know this if you have access to it.

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Gewt92 t1_iug2ozu wrote

Ah you weren’t using code as cardiac arrest.

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I-goes-to-eleven t1_iugb8uq wrote

In about 99% of code situations, a mg of epi and an amp of atropine will be given within a minute of beginning compressions in the hospital setting, and will continue to be given to reach stability or until a continuous pressor has been started.

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Gewt92 t1_iugi5r3 wrote

No one uses atropine for cardiac arrests here anymore. I haven’t seen it used in a cardiac arrest in years.

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I-goes-to-eleven t1_iugoa2u wrote

We give it initially with epi because it helps with secretions and intubation. After that its just epi. By that time pacing pads are in place.

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MrTastey t1_iuh5ota wrote

Protocols vary wildly state to state, service to service and probably more so in different countries

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Gewt92 t1_iuh6b99 wrote

https://emedicine.medscape.com/article/757257-medication#1

Giving a shit ton of atropine and Epi for Asystole/PEA isn’t recommended anymore. I know people have different protocols elsewhere but evidence based medicine suggests they shouldn’t.

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I-goes-to-eleven t1_iuhecec wrote

ACLS says otherwise. Current standards instruct epi every 3-5 min. Any provider over 40 gives atropine also to start for the reasons I gave above.

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NoMalarkyZone t1_iuheo7q wrote

Atropine isn't part of ACLS for any cardiac arrest. Only symptomatic bradycardia.

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I-goes-to-eleven t1_iuhpbxw wrote

Epinephrine. See how I linked this to the algorithm? Atropine is for reducing respiratory secretions and also given with initial dose only of epinephrine to sustain a recoverable rhythm at the discretion of the provider. This is how I do it most of the time, unless something tells me it’s unnecessary. And with most of my codes and rapid responses, there is a respiratory component that initial dose of atropine will benefit from. I forgot how many “internet doctors” are on Reddit. I typically do not engage for this very reason. Thanks for reminding me.

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NoMalarkyZone t1_iuhpym9 wrote

Maybe most "providers" give atropine to a dead heart but it's not part of ACLS, and most physicians don't.

In fact i don't think I've never seen an ED physician or intensivist give atropine to a pulseless person. There's no evidence of that helping in asystole, or anything other than symptomatic bradycardia - essentially pre-arrest.

Maybe follow the guidelines? It would also help to be less combative with everyone you're talking to.

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9Lives_ t1_iug884u wrote

Its also great for pain relief in micro doses, I’ve heard (through anecdotal reports) that opiates will make you ok with the pain whereas this datura derivative will eradicate the pain.

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Alexstarfire t1_iuh6r3a wrote

Is it because it falls off? You're supposed to keep the meds inside.

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