Category: Return of Spontaneous Circulation

What is the role of dopamine in a ROSC and Symptomatic Bradycardia? Atropine?

Question:

You have an adult patient who is post cardiac arrest. They are bradycardic (rate 30-40) and profoundly hypotensive (blood pressure unobtainable). You have the patient intubated with an IV in place and flowing well. Of course the first response in this situation is to initiate a fluid bolus. What I'm specifically wanting to get clarified is the role of dopamine.

In the ROSC medical directive the patient simply needs to meet the condition of "hypotension" for a dopamine infusion to be started with no patch required. In the Symptomatic Bradycardia medical directive dopamine requires the heart rate to also be <50bpm and a patch to initiate the infusion.  In the situation of a post-arrest patient who is also bradycardic, is a patch required in order to initiate a dopamine infusion or would the expectation be that a paramedic would initiate the infusion? Should we initiate dopamine and then patch for pacing as well?  Secondarily, what role/timing would Atropine play in all of this?

Answer:

No, a patch is not required to administer dopamine as the post ROSC supersedes symptomatic bradycardia medical directive. Atropine would unlikely help in this scenario and you should go directly to pacing.

MedicASK Categories

MedicASK Search

Local: 613-737-7228 | Long Distance: 877-587-7736

Ottawa, 2475 Don Reid Drive, Ottawa, On, K1H 1E2
Kingston, 400-1471 John Counter Blvd, Kingston, ON, K7M 8S8