ATROPINE ADMINISTRATION BY MEDICAL DIRECTIVE IN CCTC
Atropine sulfate is a parasympatholytic (parasympathetic blocker). It blocks the vagal effects on the SA and AV nodes, which is to slow the SA node rate and reduce the conduction speed through the AV node. As a results of the vagal blockade, the heart rate and AV velocity increases.
.Administration of this drug can be performed by certified critical care nurses by Medical Directive.
A certified critical care nurse in CCTC may give atropine by Medical Directive in the following circumstances:
• Heart rate < 60 bpm and
• At least one sign or symptom related to the bradyarrhythmia (e.g. hypotension, decreased level of consciousness, chest pain).
Contraindicated in patients with glaucoma, myasthenia gravis, asthma, obstructive diseases of GI tract, intestinal atony, obstructive uropathy.
Bradyarrhythmias should only be treated if symptomatic.
Atropine may restore normal AV conduction for supraventricular bradyarrhythmias.
Less frequently, atropine may cause paradoxical slowing of heart rate. Atropine is unlikely to be beneficial if conduction disturbance is below the AV node .
These conditions can be aggravated by parasympathetic blockade, therefore, DO NOT give atropine in Complete Heart Block.
An certified critical care nurse may administer a dose of Atropine 0.5 mg IV direct by Medical Directive.
An certified critical care nurse may repeat the dose of atropine every 3 minutes up to a maximum total dose of 3 mg by Medical Directive.
Atropine increases heart rate through parasympathetic blockade.
Notify the critical care physician. Further treatment of investigation may be required.
Monitor Side Effects
Monitor for side effects of atropine.
Clinical signs and symptoms may include tachycardia causing myocardial ischemia, blurred vision, dry mouth, urinary retention or delirium.
Document the administration and effect of atropine in the clinical record and medication administration record.
The CNO identifies the nurse as competent to perform this skill and accountable for practice. Documentation provides evidence of clinical decision making and activation of protocol driven practice under medical directive.
During a cardiac arrest, document the atropine in the cardiac arrest record.
When atropine is given outside a cardiac arrest situation, the certified critical care nurse enters the order and identifies "Medical Directive" as the authority.
In an emergency situation where the cardiac arrest record is not being used, back sign for the atropine in the MAR.