Doczilla Posted March 12, 2009 Share Posted March 12, 2009 (edited) Can you really be so sure it WILL help? After a quick check there are quite a few reports of atropine being ineffective in the setting of digoxin overdose. I am happy to be proven wrong but it was this unknown quantity that provided my main justification for advocating cardiac pacing if I had to only choose ONE treatment - as per your question. I would be keen hear your answer and justification to your question Doczilla on which ONE you would choose in the scenario - drugs or pacing? Stay safe, Curse a) Dial back the attitude. The reasons for choosing atropine over pacing were covered in my previous post. That's not to say you would never pace someone who is possibly dig toxic. c) I phrased the question this way because I didn't want the dogmatic answer that anyone would come up with who has taken ACLS of "atropine, pacing" or "pacing, because atropine never works on heart blocks". This is one of those cases where not all bradycardias are the same, and it's important not to do something simply because the algorithm says so. It's not enough to know to do it; you should know why you are doing it. By putting someone to a choice, and having them justify it, you see who really knows why one is appropriate over another. 'zilla Edited March 12, 2009 by Doczilla Link to comment Share on other sites More sharing options...
Camulos Posted March 12, 2009 Share Posted March 12, 2009 (edited) a) Dial back the attitude. The reasons for choosing atropine over pacing were covered in my previous post. That's not to say you would never pace someone who is possibly dig toxic. c) I phrased the question this way because I didn't want the dogmatic answer that anyone would come up with who has taken ACLS of "atropine, pacing" or "pacing, because atropine never works on heart blocks". This is one of those cases where not all bradycardias are the same, and it's important not to do something simply because the algorithm says so. It's not enough to know to do it; you should know why you are doing it. By putting someone to a choice, and having them justify it, you see who really knows why one is appropriate over another. 'zilla a) I apologise if it came across as attitude as that was certainly not my intention. My use of capitals and bold was to emphasise that I wanted you to choose one treatment only - as per your original question. I will desist from using capitals in future and hope I have not caused offense as I have certainly enjoyed reading your replies, both here and on other topics, in the past. My main reason for choosing pacing over atropine was that I believe there is a high likelihood that atropine will not be effective. There are a lot of case reports of this and as such I believe the numbers support pacing, along with its inherent risks, over atropine. Your earlier post semed to assert that atropine "will" work however I don't believe it's such a sure thing and thought the word "may" would have been better used. It is this "may", this unknown quantity that caused me to choose pacing over atropine. I am guessing that you have anecdotally had some success with atropine in this setting and as such have chosen it over pacing. It would be great to hear of your experience and sucess / failure with both pacing and atropine in these cases. c) I enjoyed the fact that you worded the question the way you did as it made me really think about what my priority was. As I always have both options at my disposal I have never really had to think outside that square and as such thank you for making me do so. I am happy to be proved wrong but still believe pacing is the way to go. Keen to hear your responses, here and on other topics Doc. Stay safe, curse - note all lower case (jokes) Edited March 12, 2009 by Curse Link to comment Share on other sites More sharing options...
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