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The Sad Man and the Bottles

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Question 1:

Most sources I read stated that Atropine will be of little use because the bradycardia is not parasympathic in nature. But, can be given anyway.

Question 2:

I threw this question out there because I read in Goldfrank Toxicology (I think...sorry my reference material is not handy) stated that Atropine may prevent worsening of bradycardia due to vagal stimulation during intubation. Of course, I have never seen this done or heard of such a thing. I was wondering if other poster may have. Also, this concept flys in the face of question 1.

Question 3:

Good job Artikat!

Question 4:

Yes and no. With the IR tabs CaCl helps mitiagte the toxicity. In cases with SR tabs one can run in to issues of Ca toxicity and diminishing returns. In that Ca influx is blocked at a cellular level. Now, of course, this isn't a typical EMS problem of course. Still, interesting!

With these patients whole bowel irrigation is helpful as well as other unique therapies (high dose insulin and glucose and a few other)


Edited by DartmouthDave

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By ACLS definition this is a symptomatic bradycardia ... so why NOT pace ?

as CO = rate x stroke volume this patient is hypotensive and it is partially rate related, next query would pacing be positively inotropic as well ?

Then when giving Glucagon is there anything else we should be "aware of" or field test ? yup a no brainer for most when we are using glucagon, watching the strips maybe as we could throw lots of other "labs" out of whack too.


Good point about irrigation, a bottle or 2 of the black messy stuff + cathartic down an NG will not do anything but good.

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